Respiratory- Common PC Chest Pain

Question 1

When can it arise

Answer 1

• chest wall, parietal pleura, mediastinal structures, tracheobronchial tree, pericardium, oesophagus, sub diaphragmatic structures (liver and gallbladder)

Question 2

Important feature of the pain to distinguish

Answer 2

• site
• severity
• character: sharp suggests pleural pain
• onset: gradual or rapid
• exacerbating or reliving factors
• associated Sx: breathlessness, fever and cough suggest infective cause

Question 3

PE chest pain

Answer 3

• a large PE can cause angina-like chest pain
• due to increase R ventricular work together with reduced coronary O2 supply
• this can be caused by hypotension, hypoxaemia resulting in right ventricular ischaemia

Question 4

Define pleuratic chest pain

Answer 4

• worse on inspiration and coughing
• often described as sharp/stabbing
• usually sited away from the midline
• can be localised or affect a wide area of the chest wall

Question 5

Disease causes of pleural chest pain

Answer 5

• pneumonia and pulmonary infarcts- either direct pleural inflammation or adhesions with pleural traction on respiratory movements
• pneumothorax: mechanical distortion of pleura with lung collapse
• lung ca- pleural distortion by infiltration, although constant pain is more typical

Question 6

MSK chest pain

Answer 6

• is common and may occur in with chest trauma, forceful coughing or connective tissue disorders
• the chest is characteristically tender to palate and the pain can be reproduced by respiratory movements and or movement of spine/shoulder muscles
• there may be soft tissue injury or rib #
• a detailed Hx is vital as injury can be overlooked

Question 7

Bornholm disease and costocondritis

Answer 7

• Bornholm disease is an infection with an enterovirus
• This causes acute but self-limiting inflammation of intercostal muscles.with episodes of severe unilateral intercostal myalga lasting a few days.
• Costocondritis is idsopathic inflammation of the costochondral cartiages adjoining the sterum (causing pain and tenderness). The pain is eased by simple aralgesia and settles spont

Question 8

Herpes zoster chest pain

Answer 8

• Herpes zoster infection (shingles) may start with superficial itch or burning pain in a thoracic dermatome
• followed by the appearance of a vesicular rash (a ‘belt of roses from hell’).
• Pain and altered sensation may persist long after the rash has resolved, often with scarring in the affected dermatome (area of skin affected by nerves from a single spinal root)

Question 9

Oesophagitis chest pain

Answer 9

• Burning retrosternal pain may indicate oesophagitis but also occurs with myocardial ischaemia.
• Worsening of oesophageal discomfort after eating or relief after antacids helps to distinguish it from cardiac pain.

Question 10

Medistinal chest pain

Answer 10

• Central, constant, progressive, non-pleuritic chest pain may represent mediastinal disease, particularly malignancy.
• Similarly, chest wall pain (without trauma) that is constant,progressive and non-pleuritic suggests chest wall invasion by malignancy.
• Sleep disturbance is a feature of such malignant pains.