Lecture 21 - Signs and symptoms of chest pain Flashcards
What would you ask about cough
When it started?
Duration
When do you get the cough (if lying down could be gastro-oesophageal)
Disrupt sleep (asthma)
Stridor
High pitched harsh noise during inspiration
Constant and loud
Narrowing in extrathoracic airway exacerbated during inspiration
Audible without stethoscope
Chest pain due to mediastinal structures
Acute coronary syndrome
Pericarditis
Oesophagitis/GORD
Aortic dissection
Chest pain due to pleura
Pleural effusion
Pneumothorax
Infection causing pleurisy
Pulmonary embolism causing infarct
Chest pain due to chest wall
Rib fracture
Costochondritis
Shingles (varicella zoster)
Cardiac pain
Dull
Central
Radiates to jaw and shoulder
Poorly localised
Pleuritic chest pain
Due to irritation of parietal pleura (intercostal or phrenic nerve)
- thoracic wall or shoulder tip pain
- sharp
- well localised
- worse with coughing and breathing in
Clear sputum
Chronic bronchitis
COPD
Yellow or green sputum
Infection
Bronchietasis (large volume)
Haemoptysis
TB
Lung cancer
Wheeze
High pitched musical sound on expiration
Due to narrowing of intrathoracic airways due to:
- mucous
- bronchial smooth muscle contraction
- oedema
Narrowing is exacerbated during expiration
Peripheral cyanosis
Blue discolouration of hands, feet, nose and tips of ears Due to: - cold exposure - decreased cardiac output - peripheral vasoconstriction
Central cyanosis
Blue discolouration of lips and tongue (mucous membranes)
Due to:
- significant cardiac or respiratory cause
-increased amount of deoxygenated blood arriving at tissue
Causes of clubbing
Lung cancer
Bronchiectasis
Pursed lip breathing
Seen in COPD
Increased resistance to outflow on expiration therefore less intrathoracic pressure decrease
Airways open for longer for more O2 uptake
