Differential Diagnosis- Acute Chest Pain - Other Causes Flashcards Preview

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Flashcards in Differential Diagnosis- Acute Chest Pain - Other Causes Deck (21):
1

Musculoskeletal - Classical History?

  • Sharp chest pain
  • Worse by movement and inspiration
  • Can point to where worse
  • Worse by pressure over area

2

Musculoskeletal - Classical Examination Findings?

  • Tenderness over area of pain
  • Normal exam otherwise

3

Musculoskeletal - Investigations? 

Diagnosis of Exclusion:

  • D Dimer - exclude PE
  • CXR - exclude pneumathorax or infection
  • Inflammatory markers - normal

4

Musculoskeletal - Treatment? 

  • Analgesia
  • Deep breathing to prevent infection

5

Costochondritis - Classical History?

  • focal chest wall pain,
  • may have known precipitating injury;
  • aggravated by sneezing, coughing,
  • deep inspiration,
  • twisting of the chest

6

Costochondritis - Classic Examination Findings?

  • reproducible pain, especially at the costochondral junctions
  • Normal exam otherwise

7

Costochondritis - Investigations? 

Diagnosis of Exclusion:

  • ECG/Troponin - exclude MI
  • CXR - normal

8

Costochondritis - Treatment?

  • NSAIDS
  • Physical therapy

9

GORD - Classical History

  • retrosternal burning with eating large or fatty meals
  • that can be reproduced with lying supine and relieved by sitting up;
  • relieved by antacids

10

GORD - Classical Examination Findings?

  • no specific physical findings
  • maybe tenderness over area if associated gastritis

11

GORD - Investigations?

  • therapeutic trial: relief of symptoms with short trial of proton-pump inhibitors

  • Oesophagogastroduodenoscopy:oesophageal inflammation or erosions 

  • oesophageal pH monitoring:persistently low pH (<4) may indicate reflux disease

12

GORD - Treatment?

  • Lifestyle advice
  • Antacids
  • Triple therapy

13

Anxiety or Panic Attack - Classical History?

  • sharp chest pain with anxiety,
  • dizziness or faintness,
  • palpitations, sweating, trembling or shaking,
  • fear of dying or going insane, paraesthesiae,
  • chills or hot flushes, breathlessness or choking sensation

14

Anxiety or Panic Attack - Classic Examination Findings? 

  • hyperventilation,
  • examination otherwise normal

15

Anxiety or Panic Attack - Investigations? 

  • ECG: normal
  • CXR: normal
  • HADS (hospital anxiety and depression scale) score: score >11

16

Anxiety or Panic Attack - Treatment? 

  • Reassurance 
  • CBT

17

Oesophageal Spasm - Classical History?

  • crushing substernal chest pain,
  • associated dysphagia,
  • pain does not always correlate with swallowing,
  • dysphagia precipitated by very hot or cold foods,
  • glyceryl trinitrate can relieve the pain

18

Oesophageal Spasm - Classic Examination Findings?

  • Normal

19

Oesophageal Spasm - Investigations? 

  • barium swallow: corkscrew or rosary bead appearance on barium swallow
  • oesophageal manometry:simultaneous contractions on >30% of wet swallows

20

Oesophageal Spasm - Treatment?

  • Avoid ppting foods
  • Try PPi
  • Nitrates 
  • Ca blockers
  • Phosphodiesterase inhibitors
  • Antidepressants

21

Other Differentials?

  • Gastritis
  • Peptic ulcers
  • Acute cholecystitis
  • Pancreatitis
  • Fibro
  • Tietze syndrome