Differential Diagnosis - Acute Chest Pain - Cardiac Flashcards Preview

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Flashcards in Differential Diagnosis - Acute Chest Pain - Cardiac Deck (17):
1

Cardiac?

  1. ACS
  2. Aortic Dissection
  3. Pericarditis
  4. Myocarditis
  5. Other Cardiac differerentials

2

ACS?

Classical History

  • Crushing Chest Pain
  • Radiates to neck/left arm
  • Associated nausea/SOB/sweatiness
  • Cardivascularrisk factors

3

Classical examination findings for ACS?

  • May be normal
  • Sweaty, SOB, Pain
  • CVS: S4 gallop, JVP dissetension, signs of heart failure
  • Brady/Tachy

4

Investigations findings for ACS

  • ECG: ST elevation (or new LBBB), inverted T waves, Q waves
  • Increased Trops, but normal in unstable angina
  • CXR: normal or signs of heart failure
  • Coronary angiography 

5

Treatment/Management of ACS

  • ABCDE
  • MONAC: Morphine, oxygen, nitrates, aspirin, clopidogrel
  • Primary coronary intervention

6

Aortic Dissection - Classical History?

  • Tearing chest pain of very sudden onset
  • Radiates to the back
  • Pain in other sites, head, neck, arms

7

Aortic Dissection - Classical Findings?

  • Unequal arm pulses or BPs
  • Maybe acute aortic regurgitation
  • New neuro symptoms due to carotid/vertebral artery symptoms

8

Aortic dissection - Investigation findings?

  • CXR: Widened mediastinum
  • CT angio or transoesophageal echo
  • ECG: signs of MI

9

Aortic Dissection - Treatment?

  • Type A - surgical repair
  • Type B - BP control

10

Pericarditis - Classical History

  • Retrosternal/precordial pleuritic chest pain
  • Relieved by sitting forward
  • Radiates to the traps, neck, shoulders
  • Viral prodrome common

11

Pericarditis - Classical Examination findings?

  • Pericardial rub
  • Tachy
  • JVP disstension and pulsus paradoxus could indicate tamponade

12

Pericarditis - Investigation findings?

  • ECG: PR depression, saddle shaped ST elevation
  • CXR: Maybe globular heart if effusion present
  • Echo: If suspect effusion

13

Pericarditis - Treatment?

  • NSAIDS
  • Treat cause if known

14

Myocarditis - Classical History?

  • Chest pain
  • Palpitations
  • Fever
  • Fatigue
  • Dyspnoea

15

Myocarditis - Classical Examination Findings?

  • ECG: Diffuse T wave inversions, ST elevation/Depression
  • Inflammatory markers raised
  • Trops raised
  • Myocardial biopsy if required

16

Myocarditis - Treatment?

  • Supportive
  • Bed rest

17

Other Cardiac Differentials?

  • Stable angina
  • Tamponade
  • Mitral valve prolapse
  • Pulmonary Hypertension
  • Aortic stenosis
  • Arrhrythmias