Noncardiac chest pain Flashcards
Name immediate life-threatening causes of chest pain (6)
- MI
- Aortic dissection
- EP
- Tension pneumothorax
- Esophageal perforation
- Pericardial effusion with tamponade
Define : BOERHAAVE SYNDROME (2)
- Barotrauma-induced rupture of the esophagus,
- usually caused by vomiting.
Define : MEDIASTINITIS
Potentially life-threatening inflammation or infection of the mediastinum (thoracic space bordered by pleura, thoracic outlet, and diaphragm that contains many vital structures including the heart, great vessels, trachea, and esophagus).
Define : MACKLER TRIAD (1)
Vomiting followed by lower chest pain and subcutaneous emphysema.
Define : HAMMAN’S CRUNCH
“Mediastinal crunch,” which is a scratchy or crackly sound
heard with each heartbeat due to surrounding air confined within the mediastinum.
Define : PLEURITIC
Associated with deep breathing, coughing, sneezing, or laughing.
The most common cause of esophageal perforation is what?
actually iatrogenic, due to endoscopy.
However, these perforations are distinct from
the effort- and pressure-related rupture known as Boerhaave syndrome.
Describe triad : Boerhaave syndrome (3)
Mackler triad
* vomiting
* lower chest pain
* subcutaneous emphysema
Name CARDIOVASCULAR DDX of chest pain (4)
- ACS/STEMI
- Aortic dissection
- Cardiac tamponade
- Pericarditis
Describe clinical presentation and dx study : Pericarditis
- Chest pain improved with leaning forward, pericardial friction rub, diffuse ST segment elevation
- Dx : ECG
Describe clinical presentation and dx study : Aortic dissection
- Tearing chest pain radiating into back, symptoms involving two organ systems, can be hypotensive or hypertensive, ill appearing
- Dx study : CT angiogram
Describe clinical presentation and dx study : Cardiac tamponade
- Tachycardia and shock, Beck triad, pulsus paradoxus, electrical alternans
- Dx : POCUS
Name PULMONARY DDX of chest pain (3)
- EP
- Tension pneumothorax
- Pneumonia
Describe clinical presentation and dx study : EP
- Pleuritic chest pain, dyspnea, tachycardia, tachypnea, hypoxia with relatively normal CXR, right heart strain on ECG, and POCUS
- Dx : D-dimer, CT angiogram
Describe clinical presentation and dx study : Tension pneumothorax
- Penetrating trauma or blunt trauma, shortness of breath, tachypnea, shock, deviated trachea, unilateral breath sounds
- Dx : Clinical dx, POCUS, CXR
Describe clinical presentation and dx study : Pneumonia
- Fever, cough, pleuritic chest pain, hypoxia, focal abnormal breath sounds
- Dx : Clinical diagnosis, CXR
Name GI DDX of chest pain (5)
- Boerhaave syndrome
- Cholecystitis
- Pancreatitis
- GERD
- Esophageal spasm
Describe clinical presentation and dx study : Boerhaave syndrome
- Acute onset chest pain, fever, tachypnea
- Dx : CT
Describe clinical presentation and dx study : Cholecystitis
- Chest pain with RUQ or epigastric pain, anorexia, RUQ tenderness
- Dx : POCUS
Describe clinical presentation and dx study : Pancreatitis
- Epigastric pain radiating to the back, vomiting, marked abdominal tenderness
- Dx : Elevated lipase, CT
Describe clinical presentation and dx study : GERD
- Substernal burning chest pain, worse with lying down flat, worse at night, sour taste in mouth
- Dx : Clinical diagnosis
Describe clinical presentation and dx study : Esophageal spasm
- Chest pain with dysphagia or odynophagia
- Dx : EGD, manometry
Name MUSCULOSKELETAL DDX of chest pain (3)
- Muscle strain
- Costochondritis
- Breast pathology
Describe clinical presentation and dx study : Muscle strain
- Chest pain worse with movements, sometimes pleuritic
- Dx : Physical exam
Describe clinical presentation and dx study : Costochondritis
- Chest pain with tenderness to palpation near sternal border
- Dx : Physical exam
Name beck Triad : Pericardial Tamponade
- hypotension
- jugular venous distention
- muffled heart sounds
Describe tx : Pericardial Tamponade (5)
Initial treatment
* maximizing venous return with volume expansion
* elevating the legs
* and avoiding positive pressure ventilation if possible.
Definitive decompression of the pericardium can be achieved with
* pericardiocentesis
* or a surgical pericardial window.
Treatment of uncomplicated pericarditis consists of what?
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- colchicine
- close follow-up.
Describe tx : EP (2)
- Treatment involves immediate anticoagulation with heparin or a direct oral anticoagulant.
- Shock or cardiac arrest from PE is an indication for** thrombolytic therapy**.
Describe tx : Tension Pneumothorax (2)
Emergent treatment involves
* needle decompression of the hyper-resonant hemithorax with a large gauge needle or angiocath
* followed by tube thoracostomy.
Name elements that predispose to reflux (3)
Caffeine, alcohol, and tobacco use all decrease lower esophageal sphincter
pressure and predispose to reflux.
