Week 11.2 - Chest Pain

Question 1

List the causes of chest Pain

Answer 1

Cardiac
Vascular
Respiratory
Gastrointestinal
Neurological
Musculoskeletal

Question 2

Questions to ask about the presenting pain

Answer 2

duration, site, intensity, quality, continuous or intermittent, radiation, have they experienced it before?
Exacerbating factors
RElieving factrs
Other symptoms

Question 3

List the warning signs of a heart attack

Answer 3

Pain pressure, heaviness or tightness
Is the pain in the cheat, neck, jaw arns, back or shoulders?
Nausea, cold sweat, dizzy, SOB

Question 4

What is Crushing, tight band like pain in the center anterior chest indicitive of

Answer 4

Myocardial infarction

Question 5

What is Myocardial pain exaggerated and relieved by

Answer 5

Exacerbated: exertion, anxiety, cold

Relieved but rest and nitrate

Question 6

Associated features of a Myocardial infarction

Answer 6

Often sweaty, breathless and shocked, might feel nauseated

Question 7

What is aortic dissection

Answer 7

high pressure in the lumen and damage to media causes a tear in the intima
blood enters and dissect the luminal plane

Question 8

List the Signs of aortic dissection

Answer 8

shock, cyanosis, sweating
BP and pulses differ between extremities
Aortic regurgitation, cardiac tamponade, cardiac failure

Question 9

What is shock ( Circulator shock)

Answer 9

Cardiovascular dysfunction where inadequate oxygen being delivered to tissues

Question 10

What are the symptoms of Aortic Dissection

Answer 10

Central tearing chest pain radiating to back

Question 11

Investigations for Aortic Dissection

Answer 11

• CXR - widened mediastinum
  ECG - ST elevation
  CT?MIR _ false lumen
  Echocardiography - pericardial effusion

Question 12

What are the symptoms of Aortic Dissection

Answer 12

Pain: Sharp, stabbing, tearing
Site: Retrosternal, interscapular
No radiation
COnstant
Associated features: Unequal radial and femoral pulse and BP.  Aortic Regurgitant mumur may be heard on auscultation

Question 13

What are the symptoms of Pericarditis

Answer 13

Quality of Pan: SHarp (May be curshing)
Site: Central anterior
Usually no radition
Exacerbated: when lying back
relieved by sitting
Associated features: fever, recent viral illness

Question 14

Name the respiratory causes of chest pain and associated features

Answer 14

Pleurisy, PE, Pneumothorax and tumors

Associated features: COugh, heamoptysis, Shock (PE), Dyspnoea

Question 15

What are the characterisitcs of Gastrointestinal chest pain

Answer 15

Quality: Burning pain
Site: central
Radiation: to throat
Exacerbating: Ulcer pain relieved by food and antacidies.  Cholecystitis and oesophageal pain are exacerbated by food
Associated features  - excessive wind

Question 16

Muskuloskeletal causes of chest pain

Answer 16

Rib traum
Referred pan
SCJ disorders
SC joint sprain
Intercostal muscl strain etc

Question 17

What is Herpes zoster

Answer 17

Shingles!

Reactivation of Varicella zoster in the sensory gangion

Question 18

What are symptoms of shingles

Answer 18

Headache, fever, malaise, followed by itching, tingling and pain in a dermotomal distribution followed by a rash

Question 19

List the investigations done for chest pain

Answer 19

ECG, PCI, CXR, Biochemical marker - Creatine Kinase, Troponin
Oximetry and ABG’s
Echocardiography, CT scan, MRI, CTPA, V/Q scan
Exercise test or perfusion scan