What is causing pleuritic chest pain? Flashcards
What is the pathophysiology of pulmonary embolism?
What could indicate a PE from a history?
HPC
- Pleuritic Chest pain
- Breathlessness
- Haemoptysis
- Palpitations
- Syncope / pre-syncope
- Calf swelling / pain
- Other symptoms of concern – weight loss, reduced appetite, bleeding PR
PMH
- Previous DVT / PE
- Malignancy
- Recent cardiac event
- Recent surgery (especially related to lower limb)
- Connective tissue disease
- Previous miscarriages
- Varicose veins
Medications
- Oral contraceptive pills
- Anticoagulants – compliance / therapeutic INR
Family History
- H/o VTEs
- Thrombophilias
- Connective tissue disorders
Social history
- Smoking
- Travel history
- Mobility
What could indicate a PE from an examination?
General
- Breathless
- Recent surgery - ?lower limb in cast / splint
Obs
- HIGH HR
- HIGH RR
- LOW SpO2
- O2 requirement
- LOW BP
Respiratory
- Normal
- Reduced air entry / crackles (due to effusion)
Cardiovascular
- Raised JVP
- Palpable / loud P2
- Left parasternal heave (due to right ventricular hypertrophy)
- Pedal oedema
Other
- Signs of DVT
- Connective tissue disease
- Thyroid disease
What investigations would you do with someone with a PE?
- D-dimer (normal → no DVT or PE)
- CTPA = gold standard
- TFT → increase risk of PE due to thyroid issues
Explain the Well’s score and what it is used for?
Used for PE
What is the management of PE?
- Anticoagulation
- Thrombolysis (if life-threatening)
- Determine and treat the underlying cause
What is Pulmonary hypertension? (types, history, examination, investigations, treatment)
Elevated pulmonary pressures (arterial / venous); mPAP (mean pulmonary arteriole pressure) > 25 mmHg
Types
- Idiopathic / Familial (no known cause)
- Cardiac
- Pulmonary (e.g. COPD)
- CTEPH
- Misc
History
- Exertional dyspnoea
- Palpitations
- Syncope
Examination
- Elevated JVP
- Loud P2
- LPH
- Pedal oedema
Investigations
- Echo
- BNP
- CTPA
- V/Q scan
- RHC
Treatment
- Per cause
What is the pathophysiology behind a pneumothorax?
What could indicate a pneumothorax from a history?
HPC
- Pleuritic Chest pain – sudden onset
- Breathlessness
- “Pop” sensation
- Sometimes a trigger – lifting heavy weight / trauma / fall
PMH
- Previous PTX
- COPD
- Alpha-1 antitrypsin deficiency
- Underlying lung disease
- Valvular heart disease (with Marfan’s INCREASE risk of pneumothorax due to this)
Medications
- Inhalers
- Anti-fibrotics (clues to underlying lung disease)
FH
- H/o PTX
- H/o AAT, Marfan’s
Social history
- Smoking (cigarettes, cannabis) → increases risk of pneumothorax
- Occupation
What could indicate a pneumothorax from a history?
HPC
- Pleuritic Chest pain – sudden onset
- Breathlessness
- “Pop” sensation
- Sometimes a trigger – lifting heavy weight / trauma / fall
PMH
- Previous PTX
- COPD
- Alpha-1 antitrypsin deficiency
- Underlying lung disease
- Valvular heart disease (with Marfan’s INCREASE risk of pneumothorax due to this)
Medications
- Inhalers
- Anti-fibrotics (clues to underlying lung disease)
FH
- H/o PTX
- H/o AAT, Marfan’s
Social history
- Smoking (cigarettes, cannabis) → increases risk of pneumothorax
- Occupation
What could indicate a pneumothorax from an examination?
General
- Breathless
- Inhalers / oxygen concentrator
- Nicotine replacement patch / gum
- Tar stained nails
- Drain in place
Obs
- HIGH HR
- HIGH RR
- LOW SpO2
- O2 requirement
- LOW BP
Respiratory
- Trachea
- Reduced chest wall movement / expansion
- Accessory muscle use
- Intercostal / subcostal recession
- Hyper-resonant note
- Absent breath sounds
Cardiovascular
- Displaced apex beat
- Murmurs (Marfan) → as heart valve disease
Other
- Tall stature
- High arched palate
- Arachnodactyly, wrist sign, thumb sign
What are the investigations to do with someone with a pneumothorax?
- CXR → absence of lung markings
- CT scan → able to see well
What are the managements of someone with a pneumothorax?
- Observation
- Aspiration
- Chest drain
- Pleural Vent
SUMMARISE PE & pneumothorax (management, examination, investigation and management)
