Chest pain

Question 1

Myocardial infarction pain

Answer 1

Cardiac-sounding pain
heavy, central chest pain they may radiate to the neck and left arm
nausea, sweating
elderly patients and diabetics may experience no pain

Risk factors for cardiovascular disease

Question 2

Pneumothorax

Answer 2

History of asthma, Marfan’s etc

Sudden dyspnoea and pleuritic chest pain

Question 3

PE

Answer 3

Sudden dyspnoea and pleuritic chest pain
Calf pain/swelling
Current combined pill user, malignancy

Question 4

Pericarditis

Answer 4

Sharp pain relieved by sitting forwards

May be pleuritic in nature

Question 5

Dissecting aortic aneurysm

Answer 5

‘Tearing’ chest pain radiating through to the back

Unequal upper limb blood pressure

Question 6

GORD

Answer 6

Burning retrosternal pain

Other possible symptoms include regurgitation and dysphagia

Question 7

MSK pain

Answer 7

One of the most common diagnoses made in the Emergency Department. The pain is often worse on movement or palpation.

May be precipitated by trauma or coughing

Question 8

Singles

Answer 8

Pain often precedes the rash

Question 9

Features of Aortic dissection

Answer 9

Flap or filling defect within the aortic intima
Blood tracks into the medial layer and splits the tissue and creates a false lumen
- Common around Afro-caribbean males aged 50-70 years

Question 10

Pulmonary embolism

Answer 10

Chest pain, haemoptysis, hypoxia and small pleural effusions
Underlying deep vein thrombosis
S waves in lead I, Q waves in elad III and inverted T waves in lead III
CTPA - diagnostic