Chest Pain Flashcards
Life threatening causes
MI Massive pulmonary embolus and infarction Ruptured aortic aneurysm Aortic dissection - rare, tearing Ruptured oesophagus
Chest pain history
Site of pain Quality and intensity Pattern and duration Exacerbating factors Associated symptoms Relieving factors
What makes it cardiac related
Front of chest, mid or upper sternum
Radiating to left arm/round the chest/jaw
Described as tight, heavy, constricting, crushing, numbing or burning
Pericarditis (other cause)
Mediastinal (central) pain, referred to shoulder & back
Often sharp in nature, but can be dull
Made worse by breathing, coughing, sneezing
Influenced by posture, typically relieved by sitting forward
Can happen after MI, viral infection
Oesophagus (other cause)
Reflux disease: burning, crushing, sharp, continuous; relieved by alkaline substances; worse after eating/bending forward/lying flat; chronic, not sinister, sudden onset
Oesophageal rupture: rare, can result in mediastinitis
Lungs (other causes)
Most of lower respiratory tract is insensitive to pain, but pleura are sensitive
Infection
CURB65
Can get effusion, empyema or pleurisy as complications
Carcinoma, pneumothorax, trauma, thrombus (PE) and immunological (e.g. vasculitic) causes also contribute to chest pain presentations
Pleuritic (other cause)
Severe, stabbing, sharp, one sided, worse on inspiration
PE - due to cardiac ischaemia; Wells score tools and PERC rule out PE
Musculoskeletal causes
Induced/relieved by postural change
Highly localised
Reproduced by pressure
Tietze’s syndrome – costochondritis: more common in males, 20-30 years old; pain localised to costal cartilage, usually palatable; exacerbated by coughing, sneezing, motion; usually post viral URTI
Neurological causes
Neuralgia and neuropathy caused by herpes zoster, nerve roots compressed by vertebral body collapse, metastatic growth/invasion, infection
Other causes: mastitis, mastalgia, gynaecomastia, cysts, anxiety
