9. Chest Pain

Question 1

What causes of chest pain require immediate management?

Answer 1

Acute coronary syndrome
Aortic dissection
Pneumothorax
PE
Borrhaave's perforation

Question 2

What are some of the features of ACS?

Answer 2

Sudden onset crushing pain, radiates to the arm/ jaw, signs of hypercholesterolemia/ PVD

Question 3

What are some of the features of aortic dissection?

Answer 3

Tearing pain to the back, difference in BP between 2 arms >20 mmHg, Hx of hypertension, new onset aortic regurgitation and pleural effusion

Question 4

What are some of the features of a pneomothorax?

Answer 4

Pleuritic chest pain, asymmetrical chest expansion, hyper-resonance, absent breath sounds, tracheal deviation in tension pneumothorax

Question 5

What are the features of a PE?

Answer 5

Sudden SOB, tachycardic, risk factors present- previous DVT, long period of immobility, oral contraceptive pill

Question 6

What are the features of boerhaave’s perforation?

Answer 6

Chest pain after vomiting with sudden onset

Question 7

What drugs do patients with ACS needed to be started on?

Answer 7

MONABASH
Morphine and metoclopromide
Oxygen only if needed to keep sats over 94%
Nitrates for vasodilation
Antiplatelets- aspirin plus other agents
Beta blockers 
Ace inhibitors 
Statins
Heparin