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Flashcards in Chest Pain Deck (33):
1

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)
- Musculoskeletal

2

What should be included in the history for a patient with chest pain?

- Presenting complaint
- Past medical history
- Drug history
- Family history
- Social history

3

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
- Hypertension
- Diabetes, high cholesterol

4

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)

5

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)
- Continuous/intermittent
- Radiation of pain
- Experienced before
- Aggravating/easing factors
- Other symptoms at same time (nausea, SOB, sweating)

6

What does CVD include?

Heart, stroke and blood vessel diseases

7

What are the warning signs of a heart attack?

- Pain, pressure, heaviness or tightness in jaw, neck, shoulders, chest, back, arms
- Nausea
- Dizziness
- Cold sweat
- SOB

8

How are the heart attack signs different for women?

More than 40% don't experience chest pain

9

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

10

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

11

What is the primary risk factor for aortic dissection?

Hypertension

12

What are the signs of aortic dissection?

- Shock, cyanosis, sweating
- BP & pulses differ between extremities
- Aortic regurgitation, cardiac tamponade, cardiac failure

13

What is circulatory shock?

CV dysfunction, inadequate O2 being delivered to tissues

14

What are the types of causes of circulatory shock?

- Hypovolaemic
- Septic
- Cardiogenic
- Anaphylactic
- Spinal
- Neurogenic
- Toxic

15

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)

16

What are the aortic dissection investigations?

- CXR: widened mediastinum
- ECG: ST elevation
- CT/MRI: False lumen
- Echo: Pericardial effusion

17

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

18

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

19

What are some of the causes of pericarditis?

- Viral illness
- Injury to the chest
- Cardiac surgery
- Heart attack

20

What are some of the respiratory causes of chest pain?

- Pleurisy
- PE
- Pneumothorax
- Tumours

21

What features are associated with respiratory causes of chest pain?

- Cough (may be productive)
- Haemoptysis
- Shock (PE)
- Dynpnoea

22

What are the causes of dyspnoea?

- Cardiac failure
- Coronary artery disease
- Pulmonary embolism
- Pneumothorax
- COPD, asthma

23

What chronic dyspnoea signs are associated with heart failure?

- Orthopnoea
- Paroxysmal nocturnal dyspnoea

24

What acute dyspnoea signs are associated with heart failure?

- Crackles/wheezes
- Pink, frothy sputum
- APO
- Pneumothorax
- PE

25

What are the outcomes of right and left sided heart failure?

Right: Peripheral oedema
Left: Pulmonary oedema

26

What are the pain characteristics of GI causes of chest pain?

Quality: Burning
Site: Central
Radiation: To throat
Agg: Food (oesophageal pain & cholecystits)
Eas: Food & antacids (peptic uler pain)
Associated: Excessive wind

27

What are the likely causes of musculoskeletal chest pain?

- Rib trauma (fracture, contusion)
- Referred pain from TS
- Sternoclavicular joint disorders

28

What are the less likely causes of musculoskeletal chest pain?

- Costochondritis
- Sternocostal joint sprain
- Intercostal muscle sprain
- Rib stress fracture
- Fractured sternum

29

What are the NTBM causes of musculoskeletal chest pain?

- Cardiac causes
- Peptic ulceration
- GI reflux
- Pneumothorax
- PE
- Herpes zoster

30

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

31

What factors differentiate chest pain referred from TS, rather than myocardial infarction?

- Age
- History of injury
- Site/radiation
- Type of pain
- Agg/eas factors
- Associations

32

What are the investigations for suspected heart attack?

- ECG (first)
- PCI
- CXR
- Biochemical markers
- Oximetry & ABGs
- Echocardiography, CT, MRI, CTPA, V/Q scan
- Exercise test

33

What are the management options for coronary artery disease?

- CABG
- PCI (percutaneous coronary intervention): Wire inserted into artery, balloon blown up to push blockage aside