Chest Pain Flashcards
What key history would you obtain from a patient who has a complaint of chest pain?
Location
Quality
Severity
Radiation
Duration
Context (exertional, postprandial, positional, cocaine use, trauma)
Associated symptoms (sweating, nausea, dyspnea, palpitation, sense of doomP
Exacerbating or alleviating factors (medicines)
Prior history of similar symptoms
Known heart or lung disease
Cardiac Risk Factors (HTN, hyperlipidemia, smoking, family history of early MI)
Pulmonary embolism risk factors (history of DVT, coagulopathy, malignancy, recent immobilization)
What key physical exams would be performed on a patient with complaint of chest pain?
Vital signs + BP in both arms
Complete cardiovascular exam (JVD, PMI, chest wall tenderness, heart sounds, pulses, edema)
Lunch and abdominal exams
60 yo M presents with sudden onset of substernal heavy chest pain that has lasted for 30 minutes and radiates to the left arm. The pain is accompanied by dyspnea, diaphoresis, and nausea. He has a history of hypertension, hyperlipidemia, and smoking. Differentials?
Myocardial infarction (MI) GERD Angina Costochondritis Aortic dissection Pericarditis Pulmonary embolism Pneumothorax
60 yo M presents with sudden onset of substernal heavy chest pain that has lasted for 30 minutes and radiates to the left arm. The pain is accompanied by dyspnea, diaphoresis, and nausea. He has a history of hypertension, hyperlipidemia, and smoking. Differentials: MI, GERD, angina, costochondritis, aortic dissection, pericarditis, pulmonary embolism, pneumothorax. Workup?
EKG CPK-MB, troponins (serial) CXR CBC, electrolytes Echocardiography Cardiac catheritization
20 yo African-American F presents with acute onset of severe chest pain. She has a history of sickle cell disease and multiple previous hospitalizations for pain and anemia management. Differentials?
Sickle cell disease - pulmonary infarction Pneumonia Pulmonary embolism MI Pneumothorax Aortic dissection
20 yo African-American F presents with acute onset of severe chest pain. She has a history of sickle cell disease and multiple previous hospitalizations for pain and anemia management. Differentials: sickle cell disease - pulmonary infarction, pneumonia, pulmonary embolism, MI, pneumothorax, aortic dissection. Workup/
CBC, reticulocyte count, LDH, peripheral smear ABG CXR CPK-MB, troponin ECG V/Q scan CT - chest with IV contrast
45 yo F presents with a retrosternal burning sensation that occurs after heavy meals and when lying down. Her symptoms are relieved by antacids. Differentials?
GERD Esophagitis Peptic ulcer disease Esophageal spasm MI Angina
45 yo F presents with a retrosternal burning sensation that occurs after heavy meals and when lying down. Her symptoms are relieved by antacids. Differentials: GERD, esophagitis, peptic ulcer disease, esophageal spasm, MI, angina. Workup?
ECG
Barium swallow
Upper endoscopy
Esophageal pH monitoring
55 yo M presents with retrosternal squeezing pain that lasts for two minutes and occurs with exercise. It is relieved by rest and is not related to food intake. Differentials?
Angina
GERD
Esophageal spasm
Esophagitis
55 yo M presents with retrosternal squeezing pain that lasts for two minutes and occurs with exercise. It is relieved by rest and is not related to food intake. Differentials: angina, GERD, esophageal spasm, esophagitis. Workup?
EKG CPK-MB, troponins CXR CBC, eletrolytes Exercise stress test Upper endoscopy/pH monitor Cardiac catheterization
34 yo F presents with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI one week ago. Differentials?
Pericarditis Aortic dissection MI Costocondritis GERD Esophageal rupture
34 yo F presents with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI one week ago. Differentials: pericarditis, aortic dissection, MI, costocondritis, GERD, esophgeal rupture. Workup?
EKG CPK-MB, troponin CXR Echocardiography CBG Upper endoscopy
34 yo F presents with stabbing chest pain that worsens with deep inspiration and is relieved by aspirin. She had a URI one week ago. Chest wall tenderness is noted. Differentials?
Costochondritis Pneumonia MI Pulmonary embolism Pericarditis Muscle strain
34 yo F presents with stabbing chest pain that worsens with deep inspiration and is relieved by aspirin. She had a URI one week ago. Chest wall tenderness is noted. Differentials: costochondritis, pneumonia, MI, pulmonary embolism, pericarditis, muscle strain. Workup?
EKG
CPK-MB, troponins
CXR
CBC
70 yo F presents with acute onset of shortness of breath at rest and pleuritic chest pain. She also presents with tachycardia, hypotension, tachypnea, and mild fever. She is recovering from hip replacement surgery. Differentials?
Pulmonary embolism Pneumonia Costochondritis MI CHF Aortic dissection
