Non- cardiac chest pain

Question 1

Common causes of non-cardia chest pain

Answer 1

Peptic Ulcer Disease (PUD)
Gastroesophageal reflux disease (GERD)
Costochondritis
Acute Anxiety

Question 2

Myocardial Infection

Answer 2

acute life threaten conditions

**sudden onset not relieved by rest or NITROGLYCERINE

Question 3

Aortic dissection

Answer 3

sudden tearing pain located in the anterior or posterior chest
May radiate to arm, legs abdomen or back

Question 4

Pulmonary Embolism

Answer 4

able to point to area of pain over lung (localize pain)
dyspnea
apprehension
hemoptysis (coughing up blood)
Gripping or stabbing pain of moderate to severe intensity that may increase with deep breathing.
may radiate to neck or shoulder
risk factors :
Bedrest and orthopedic surgery

Question 5

risk factor for CAD

Answer 5

Male >45 , female >55
Family hx of premature coronary heart disease 
cigarette smoking 
hypertension 
low HDL 130

Question 6

Patients with chest pain who should be sent to the ED

Answer 6

-NON-LOCALIZED pain
-lasting >20 minutes
-Associated with : diaphoresis
dyspnea
N & V
Dizziness
Radiation
* neck, jaw, shoulder, arm
Women, older adults, and DM patients may present with atypical symptoms*

Question 7

Physical appearance in chest pain

Answer 7

-grimacing
diaphoresis 
cyanosis 
pallor 
tachypnea
-Vital signs: elevated BP 
                  aortic dissection can have hypotension
                  hyperventilation can cause chest pain

Question 8

Skin of chest pain patient

Answer 8

may have cool, pale, moist skin with acute MI, PE or aortic dissection

Question 9

Chest wall of chest pain patient

Answer 9

Costochondritis- pain with palpation over the cartilage between the sternum & ribs
Musculoskeletal pain can be reproduced with movement or palpation

Question 10

Auscultate breath sounds in chest pain patient

Answer 10

Crackles may be heard over the site of PE

Question 11

S2 heart sounds

Answer 11

new transient paradoxical S2 during pain (chest) can indicated coronary ischemia

Question 12

S4

Answer 12

indicates stressed heart which can result from MI hypertension or CAD

Question 13

irregular rhythm (heart sound)

Answer 13

often heard during MI

Question 14

Aortic diastolic murmur

Answer 14

dissecting aorta

Question 15

what cause referred pain ?

Answer 15

PUD
cholecystitis
pancreatitis

Question 16

Extremities of a chest pain patient

Answer 16

peripheral cyanosis which can indicate hypoxia
lower extremity edema can indicate heart failure
Absent peripheral pulses can occur with PE

Question 17

Costochondritis

Answer 17

No diagnostic tests needed if physical exam is normal
Treatment: application of heat
NSAIDS
education : condition is self limiting
avoid overuse and trauma
take NSAIDS with food
follow up : RTC if condition worsens or no improvement

Question 18

GERD

Answer 18

if suspect give trial dose of PPI & check for improvment
If risk factors for CAD may also do EKG and check lipids
Treatment for GERD :

Question 19

Cardiac work up for suspected post MI in no acute distress

Answer 19

• Cardiac triponins (I &T) : rise within 2-4 hours post MI and remain elevated 7-10 days
• serum cardiac enzyme (CPK)- rise 4-8 hours after MI & return to normal 48-72 hours
• SGOT & LDH : elevated later and not indicators of acute MI
• Elevated leukocytes, ESR : non specific indicators
• EKG
• Refer