Flashcards in Chest Pain Deck (33)
What are the causes of chest pain?
- Cardiac (MI, angina, pericarditis)
- Vascular (aortic dissection)
- Respiratory (PE, pneumothorax, pleurisy)
- GI (Reflux, oesophageal tear)
- Neurological (herpes zoster)
What should be included in the history for a patient with chest pain?
- Presenting complaint
- Past medical history
- Drug history
- Family history
- Social history
What should the past medical history include?
- History of CHD
- Recent operations/procedures (e.g. cardio Sx)
- History of peptic ulcer disease or use of NSAID
- Recent illness - Pericarditis might be proceeded by prodromal viral illness
- Long periods of inactivity - May precede PE
- Diabetes, high cholesterol
What should the drug, family & social history include?
- Risk factors for CHD (age, ethnicity, family Hx, smoking, obesity, physical inactivity, depression, stress)
- Heavy alcohol use (risk factor for gastritis & peptic ulcer disease)
What questions specifically regarding the chest pain should be asked?
- Duration of pain
- Site of pain
- Intensity of pain (VAS)
- Quality of pain (burning, dull etc)
- Radiation of pain
- Experienced before
- Aggravating/easing factors
- Other symptoms at same time (nausea, SOB, sweating)
What does CVD include?
Heart, stroke and blood vessel diseases
What are the warning signs of a heart attack?
- Pain, pressure, heaviness or tightness in jaw, neck, shoulders, chest, back, arms
- Cold sweat
How are the heart attack signs different for women?
More than 40% don't experience chest pain
What are the pain characteristics of myocardial ischaemia?
Quality: Crushing, tight
Site: Central anterior chest
Radiation: Throat, jaw, arms
Agg: Exertion, anxiety, cold
Eas: Rest, glyceryl trinitrate
Associated: Sweaty, SOB, nausea, shocked
What is aortic dissection?
- Damage to layers of aorta
- High intraluminal pressure causes a tear
- Blood enters & dissects the luminal plane creating a false lumen
What is the primary risk factor for aortic dissection?
What are the signs of aortic dissection?
- Shock, cyanosis, sweating
- BP & pulses differ between extremities
- Aortic regurgitation, cardiac tamponade, cardiac failure
What is circulatory shock?
CV dysfunction, inadequate O2 being delivered to tissues
What are the types of causes of circulatory shock?
What are the symptoms of aortic dissection?
- Central tearing chest pain radiating to back
- Further complications arise if dissection affects beaches of aorta (MI, hemiplegia, paraplegia, abdominal pain)
What are the aortic dissection investigations?
- CXR: widened mediastinum
- ECG: ST elevation
- CT/MRI: False lumen
- Echo: Pericardial effusion
What are the pain characteristics of aortic dissection?
Quality: Sharp, stabbing, tearing
Site: Retrosternal, interscapular
Radiation: Usually nil
Agg/Eas: Nil (constant)
Associated: Unequal pulse & BP, aortic regurgitant murmur
What are the pain characteristics of pericarditis?
Quality: Sharp, (may be crushing)
Site: Central anterior
Radiation: Usually nil
Agg: Lying back
Eas: Sitting forward
Associated: Fever, recent viral illness
What are some of the causes of pericarditis?
- Viral illness
- Injury to the chest
- Cardiac surgery
- Heart attack
What are some of the respiratory causes of chest pain?
What features are associated with respiratory causes of chest pain?
- Cough (may be productive)
- Shock (PE)
What are the causes of dyspnoea?
- Cardiac failure
- Coronary artery disease
- Pulmonary embolism
- COPD, asthma
What chronic dyspnoea signs are associated with heart failure?
- Paroxysmal nocturnal dyspnoea
What acute dyspnoea signs are associated with heart failure?
- Pink, frothy sputum
What are the outcomes of right and left sided heart failure?
Right: Peripheral oedema
Left: Pulmonary oedema
What are the pain characteristics of GI causes of chest pain?
Radiation: To throat
Agg: Food (oesophageal pain & cholecystits)
Eas: Food & antacids (peptic uler pain)
Associated: Excessive wind
What are the likely causes of musculoskeletal chest pain?
- Rib trauma (fracture, contusion)
- Referred pain from TS
- Sternoclavicular joint disorders
What are the less likely causes of musculoskeletal chest pain?
- Sternocostal joint sprain
- Intercostal muscle sprain
- Rib stress fracture
- Fractured sternum
What are the NTBM causes of musculoskeletal chest pain?
- Cardiac causes
- Peptic ulceration
- GI reflux
- Herpes zoster
What is herpes zoster?
- Reactivation of varicella zoster virus (chicken pox) in sensory ganglion
- Extremely painful
- Symptoms: Headache, fever, malaise, followed by itching, tingling, pain with dermotomal distribution, rash
What factors differentiate chest pain referred from TS, rather than myocardial infarction?
- History of injury
- Type of pain
- Agg/eas factors
What are the investigations for suspected heart attack?
- ECG (first)
- Biochemical markers
- Oximetry & ABGs
- Echocardiography, CT, MRI, CTPA, V/Q scan
- Exercise test