Chest pain

Question 1

Name 5 cardiovascular causes of chest pain

Answer 1

• ACS
• dissecting aortic aneurysm
• pericarditis
• arrhythmias
• valvular heart disease

Question 2

Name 2 GI causes of chest pain

Answer 2

• oesophagitis (GORD)

- oesophageal spasm

Question 3

Name 4 respiratory causes of chest pain

Answer 3

• PE
• pneumothorax
• pneumonia
• pleuritis

Question 4

Name 4 chest wall causes of chest pain

Answer 4

• herpes zoster
• costochondritis
• rib #
• rheumatic disease related

Question 5

What initial ix should be performed?

Answer 5

• ECG
• troponins
• CXR
• CT: if aortic dissection suspected
• CTPA if PE suspected

Question 6

What ECG findings would indicate pericarditis?

Answer 6

• widespread ST elevation or PR depression

Question 7

What are the characteristics of chest pain caused by pericarditis?

Answer 7

• sharp and pleuritic chest pain
• relieved by sitting up and leaning forwards
• preceding flu-like illness

Question 8

What is the management of pericarditis (for presumptive viral cause)?

Answer 8

• NSAIDs and colchicine

Question 9

What are the characteristics of ischaemic chest pain?

Answer 9

• diffuse, difficult to localise, central +/- radiation to jaw, shoulders and arm
• crushing/pressure-like in character
• gradually comes on with increasing intensity over time
• worsened by exertion
• relieved by rest
• associated with diaphoresis, nausea, dyspnoea

Question 10

What are some examination findings in PE (if any)?

Answer 10

• loud P2
• elevated JVP
• signs of DVT

Question 11

What are some ECG findings in PE?

Answer 11

• sinus tachycardia
• RBBB
• RV strain
• Right axis deviation
• S1, Q3, T3
• P pulmonale

Question 12

Who is at risk of pneumothorax?

Answer 12

• tall, young male
• smoker
• underlying lung disease e.g. bullous emphysema

Question 13

What clinical features suggest herpes zoster as a cause for chest pain?

Answer 13

• pain in a dermatomal pattern
• tingling/burning/throbbing pain preceding rash
• rash: erythematous papules progressing to groups of vesicles

Question 14

What are some clinical features of thoracic aortic dissection?

Answer 14

• radiation to the back between the scapulae
• ripping/tearing
• sudden onset
• assoc with syncope

Question 15

What are some examination findings of dissecting aortic aneurysm?

Answer 15

• abnormal or absent peripheral pulses
• early diastolic murmur
• low BP/shock

Question 16

What clinical features suggest GORD as a cause of chest pain?

Answer 16

• retrosternal
• burning
• relieved by antacid
• assoc with food and made worse by bending over and lying down
• acid brash

Question 17

What are some risk factors for PE?

Answer 17

• past hx of PE/DVT
• smoking
• OCP
• pregnancy
• immobilisation - long flight, surgery
• malignancy
• genetic e.g. factor V Leiden

Question 18

What should be suspected in a pt who presents with dyspnoea, progressive angina +/- syncope?

Answer 18

aortic stenosis

Question 19

If troponins are negative after 12 hours and there are no ECG changes, what is the likelihood of MI?

Question 20

What clinical features would suggest pneumonia?

Answer 20

• pleuritic chest pain
• cough +/- sputum
• dyspnoea
• fever