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Y4 Extra teaching notes > Chest pain > Flashcards

Chest pain Flashcards

1
Q

What pulses to feel in the patient presenting with chest pain?

A

Radial and femoral

(aortic coarctation, aneurysm etc)

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2
Q

What else to look at in a patient presenting with CP?

*in terms of ‘E’ element of the assessment?

A

Look at the calfs

(e.g. possible DVT → PE)

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3
Q

What else to add to the question ‘is the pain going anywhere else/radiating’?

A
  • jaw/L arm
  • BACK

(this is important as aortic aneurysm can present like that)

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4
Q

What do we do in PE if the patients present with:

  • low BP
  • ECG changes suggesting of the strain on the heart
A

thrombolysis

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5
Q

What is the possible diagnosis if a patient’s CP is:

intermittent, on and off, progressing through the weeks

A

CP is more likely to be GI related (e.g. reflux/ulcer/oesophageal spasm)

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6
Q

Condition: ACS (STEMI and NSTEMI)

What features are suggestive of that in history?

A
  • central crushing CP
  • radiating to the jaw and L arm
  • lasting >30 minutes
  • not relieved by nitrates/rest
    *
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7
Q

Condition: ACS (STEMI and NSTEMI)

What features are suggestive of that on the examination?

A
  • no murmurs
  • no temperature
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8
Q

Condition: ACS (STEMI and NSTEMI)

What investigations are suggestive of the above?

A
  • ECG → ST elevation in 2 anatomically contiguous leads
  • troponin high
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9
Q

Condition: ACS (STEMI and NSTEMI)

Treatment

A
  • oxygen
  • high dose nitrates
  • ACS protocol
  • PCI
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10
Q

Condition: Dissecting Aortic Aneurysm

What features are suggestive of that in history?

A
  • tearing pain
  • often radiating to the back
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11
Q

Condition: Dissecting Aortic Aneurysm

What features are suggestive of that on the examination? (3)

A
  • absent peripheral pulses
  • early diastolic murmur
  • low BP
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12
Q

Condition: Dissecting Aortic Aneurysm

What features are suggestive of that in the investigations and their results? (2)

A
  • CXR → widened mediastinum (suggestive)
  • CT angiogram of aorta → loss of single clear lumen (confirmatory)
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13
Q

Supportive and definitive treatment for aortic aneurysm

A
  • Supportive: oxygen, analgesia, blood transfusion
  • Definitive: surgical intervention
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14
Q

Condition: PE

What features are suggestive of that in history?

A
  • haemoptysis
  • dyspnea
  • chest pain
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15
Q

Condition: PE

What features are suggestive of that on the examination?

A
  • tachycardia
  • low bP
  • pleural rub
  • loud P2
  • signs of DVT
  • clear lung auscultation
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16
Q

Which investigation confirms PE?

A

CT angiogram

17
Q

Treatment of PE

A
  • oxygen
  • analgesia
  • treatment doze of Delraparin
  • Thrombolysis (if indicated e.g. pt not improving, strain on the heart, low BP)
18
Q

Condition: Tension pneumothorax

What features are suggestive of that in history?

A
  • sudden onset chest pain
  • sudden dyspnoea
19
Q

Condition: Tension pneumothorax

What features are suggestive of that on the examination?

A
  • low BP
  • diminished breath sounds
  • hyper resonance to percussion
  • unequal expansion of the chest wall
  • deviation of trachea
20
Q

Investigation for tension pneumothorax

A

expiration CXR

21
Q

Treatment for tension pneumothorax

A
  • insertion of large bore cannula
  • IC drain
22
Q

Oesophagitis or oesophageal spasm

  • What features are suggestive of that in history
A
  • CP when lying supine
  • CP related to ingestion of food
  • history of NSAIDs use
23
Q

Oesophagitis or oesophageal spasm

  • What features are suggestive of that on the examination?
A
  • tender epigastrium on palpation
24
Q

Oesophagitis or oesophageal spasm

  • Ix and the results
A
  • ECG → negative
  • troponins negative
  • relieved by PPI
  • oesophagitis on endoscopy
25
Q

Oesophagitis or oesophageal spasm

  • Treatment
A
  • PPI
  • lifestyle modifications
  • calcium channel blockers (if spasm)
26
Q

Chest wall pain (MSK)

What features are suggestive of that in history?

A
  • central CP
  • associated with movement of neck or rib cage
27
Q

Chest wall pain

What features are suggestive of that on the examination?

A
  • tenderness on chest wall palpation
28
Q

Chest wall pain (MSK related)

Ix and results

A
  • ECG negative
  • troponins negative
  • CXR negative
29
Q

CP related to chest wall (MSK)

Treatment

A
  • analgesia
  • decrease physical activity

Y4 Extra teaching notes (5 decks)

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