W3/L2: Approach to chest pain

Question 1

What broad categories can you group “causes of chest pain” into?

Answer 1

Cardiac
Vascular
Resp
Oesophageal
Musculoskeletal
Dermatologic

Question 2

What things fall under cardiac causes of chest pain?

Answer 2

Acute coronary syndrome
Stable angina
Pericarditis

Question 3

What’s the main vascular cause of chest pain?

Answer 3

Aortic dissection

Question 4

What things fall under resp causes of chest pain?

Answer 4

PE
Pneumonia
Pleurisy
Pneumothorax

Question 5

What things fall under oesophageal causes of chest pain?

Answer 5

Oesophagitis

Oesophageal spasm

Question 6

What things fall under musculoskeletal causes of chest pain?

Answer 6

Muscle injury or spasm

Costochondral joint inflammation

Question 7

What’s an example of a dermatologic cause of chest pain?

Answer 7

Shingles

Question 8

What’s the management of someone with an anterior STEMI?

Answer 8

Reperfuse by thrombolysis or coronary intervention

Monitor in coronary care - with defib readily available

Question 9

What things on history make MI more likely?

Answer 9

Radiating to shoulders & arms
Worse/precipitated by exercise
Associated dyspnoea

Question 10

What things on history make MI less likely?

Answer 10

Stabbing, sharp pain
Pleuritic pain
Worse on changing position
v. localised
Reproduced by palpation or morvement
v. brief or v. long
Radiates to legs