Chest pain Flashcards
What pulses to feel in the patient presenting with chest pain?
Radial and femoral
(aortic coarctation, aneurysm etc)
What else to look at in a patient presenting with CP?
*in terms of ‘E’ element of the assessment?
Look at the calfs
(e.g. possible DVT → PE)
What else to add to the question ‘is the pain going anywhere else/radiating’?
- jaw/L arm
- BACK
(this is important as aortic aneurysm can present like that)
What do we do in PE if the patients present with:
- low BP
- ECG changes suggesting of the strain on the heart
thrombolysis
What is the possible diagnosis if a patient’s CP is:
intermittent, on and off, progressing through the weeks
CP is more likely to be GI related (e.g. reflux/ulcer/oesophageal spasm)
Condition: ACS (STEMI and NSTEMI)
What features are suggestive of that in history?
- central crushing CP
- radiating to the jaw and L arm
- lasting >30 minutes
- not relieved by nitrates/rest
*
Condition: ACS (STEMI and NSTEMI)
What features are suggestive of that on the examination?
- no murmurs
- no temperature
Condition: ACS (STEMI and NSTEMI)
What investigations are suggestive of the above?
- ECG → ST elevation in 2 anatomically contiguous leads
- troponin high
Condition: ACS (STEMI and NSTEMI)
Treatment
- oxygen
- high dose nitrates
- ACS protocol
- PCI
Condition: Dissecting Aortic Aneurysm
What features are suggestive of that in history?
- tearing pain
- often radiating to the back
Condition: Dissecting Aortic Aneurysm
What features are suggestive of that on the examination? (3)
- absent peripheral pulses
- early diastolic murmur
- low BP
Condition: Dissecting Aortic Aneurysm
What features are suggestive of that in the investigations and their results? (2)
- CXR → widened mediastinum (suggestive)
- CT angiogram of aorta → loss of single clear lumen (confirmatory)
Supportive and definitive treatment for aortic aneurysm
- Supportive: oxygen, analgesia, blood transfusion
- Definitive: surgical intervention
Condition: PE
What features are suggestive of that in history?
- haemoptysis
- dyspnea
- chest pain
Condition: PE
What features are suggestive of that on the examination?
- tachycardia
- low bP
- pleural rub
- loud P2
- signs of DVT
- clear lung auscultation