Chest Pain Flashcards

1
Q

Life threatening causes

A
MI
Massive pulmonary embolus and infarction
Ruptured aortic aneurysm
Aortic dissection - rare, tearing
Ruptured oesophagus
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2
Q

Chest pain history

A
Site of pain
Quality and intensity
Pattern and duration
Exacerbating factors
Associated symptoms
Relieving factors
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3
Q

What makes it cardiac related

A

Front of chest, mid or upper sternum
Radiating to left arm/round the chest/jaw
Described as tight, heavy, constricting, crushing, numbing or burning

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4
Q

Pericarditis (other cause)

A

Mediastinal (central) pain, referred to shoulder & back
Often sharp in nature, but can be dull
Made worse by breathing, coughing, sneezing
Influenced by posture, typically relieved by sitting forward
Can happen after MI, viral infection

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5
Q

Oesophagus (other cause)

A

Reflux disease: burning, crushing, sharp, continuous; relieved by alkaline substances; worse after eating/bending forward/lying flat; chronic, not sinister, sudden onset
Oesophageal rupture: rare, can result in mediastinitis

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6
Q

Lungs (other causes)

A

Most of lower respiratory tract is insensitive to pain, but pleura are sensitive
Infection
CURB65
Can get effusion, empyema or pleurisy as complications
Carcinoma, pneumothorax, trauma, thrombus (PE) and immunological (e.g. vasculitic) causes also contribute to chest pain presentations

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7
Q

Pleuritic (other cause)

A

Severe, stabbing, sharp, one sided, worse on inspiration

PE - due to cardiac ischaemia; Wells score tools and PERC rule out PE

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8
Q

Musculoskeletal causes

A

Induced/relieved by postural change
Highly localised
Reproduced by pressure
Tietze’s syndrome – costochondritis: more common in males, 20-30 years old; pain localised to costal cartilage, usually palatable; exacerbated by coughing, sneezing, motion; usually post viral URTI

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9
Q

Neurological causes

A

Neuralgia and neuropathy caused by herpes zoster, nerve roots compressed by vertebral body collapse, metastatic growth/invasion, infection
Other causes: mastitis, mastalgia, gynaecomastia, cysts, anxiety

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