Med A - Chest Pain

Question 1

42 y/o

pc: chest pain, sudden onset, intermittent sharp and dull, radiating to both axillae. tripped over, some pain.
hpc: been out drinking, has had acid reflux but not uncommon fo rhim

SH: 10 cig per day, BMI 32

NKDA, no dx

what are some differentials?

Answer 1

1. ischaemic heart disease
2. GORD
3. MSK - trauma, bony injuries, rib fractures
4. pneumothorax
5. pericardial effusion
6. consider epigastric, splenic and hepatic pain

Question 2

What is Beck’s triad used to indicate?

Answer 2

clinical signs associated with pericardial tamponade

- excessive accumulation of fluid within the pericardial sac

Question 3

three signs of beck’s triad?

Answer 3

1. low blood pressure (weak pulse or narrow pulse pressure)
2. muffled heart sounds
3. raised jugular venous pressure

Question 4

42 y/o

pc: chest pain, sudden onset, intermittent sharp and dull, radiating to both axillae. tripped over, some pain.
hpc: been out drinking, has had acid reflux but not uncommon fo rhim

SH: 10 cig per day, BMI 32

NKDA, no dx

what investigations would you like to perform?

Answer 4

1. clinical exam and OBs
2. any rib fractures?
3. beck’s triad of tamponade
4. FBC/ U&S/CRP/LFTs
5. ABG : hypoxia, ongoing pain?
6. hba1c
7. ECG
8. echo : lv function, signs of ischaemia, regional wall motion abnormalities, effusion or pleural effusion

Question 5

Interventions for heart attack?

Answer 5

morphine

nitrates - GTN coronary artery v.dilation

aspirin and clopidogrel

IV diuretics if signs of pulmonary oedema

Fluid resus