Thoracic Pain Red Flags

Question 1

What are the 4 types of serious pathologies to screen for in a thoracic pain patient?

Answer 1

1. CVD - myocardial ischaemia or aortic dissection
2. Respiratory - pneumothorax, and respiratory infections including pneumonia
3. Malignancy - lung, rib or vertebral malignancy
4. Fracture - rib or vertebrae

Question 2

What are the red flags in a thoracic pain patient that could indicate a serious respiratory pathology?

Answer 2

1. SOB and/or dysnpoea
2. Pallor or cyanosis
3. Tachycardia
4. Persistent or productive cough

SSX ARE AGGRAVATED BY ACTIVITY AND DEEP INSPIRATION

Question 3

What are the red flags in a thoracic pain patient that could indicate a malignancy?

Answer 3

1. Pain - constant, progressive, unrelieved by MSK interventions, night pain
2. Systemic - fever, malaise, night sweats, unexplained weight loss, nausea / vomiting, itching / rash, easily bruised
3. May have Horner’s syndrome and/or UL weakness / paraesthesia in the case of a Pancoast tumour
4. May have lymphadenopathy

Question 4

What are the risk factors for tuberculosis in a thoracic pain patient?

Answer 4

Recent travel to third world countries, health care workers, over-crowded living conditions

Question 5

What are the signs of a pneumothorax in a thoracic pain patient?

Answer 5

1. UNILATERAL sharp stabbing chest pain, aggravated by coughing and deep inspiration
2. Systemic - pallor / cyanosis
3. Respiratory - SOB / dysnpoea, tachycardia
4. Traumatic onset

Question 6

What are the signs of a myocardial ischaemia in a thoracic pain patient?

Answer 6

1. Pain - chest / thoracic and may radiate to neck, jaw, arm, shoulder and interscap region
2. Respiratory - SOB / dysnpoea
3. CV - palpitations
4. Systemic - pallor, sweating, severe fatigue

SSX ARE AGGRAVATED BY ACTIVITY AND STRESS

Question 7

What are the signs of an aortic dissection in a thoracic pain patient?

Answer 7

1. Pain - sudden onset severe chest pain, may also affect Tx, LX; quality of pain described as ripping / tearing / stabbing
2. Systemic - SOB, vision loss, difficulty speaking, difficulty walking
3. Mental state change - distress, anxiety, confusion, collapse

Question 8

Which examinations should be performed if a CVD pathology is suspected in a thoracic pain patient?

Answer 8

1. Vital signs
2. CVD examination

NOTE: if AMI in progress is suspected, call an ambulance immediately without performing any examinations