Disorders of the Cardiovascular System �

Question 1

Chest Pain

Causes/ Differentials
— cardiac causes
— Non cardiac
— Other causes

Answer 1

Causes

Common Cardiac
y Stable Angina
y Acute Coronary Syndrome
y Pericarditis

Non-cardiac
y Gastro-oesophageal reflux disease
y Pulmonary Embolus (PE)
y Pneumonia
y Peptic Ulcer
y Oesophageal spasm
y Pleural effusion

Others to consider
y Aortic dissection
y Mitral valve prolapse (other valvular problem) y Coronary vasospasm
y Sickle cell disease - acute chest syndrome
y Hiatus hernia
y Oesophageal tear with mediastinitis
y Biliary tree disease
y Costochondritis
y Nerve root compression
y Cardiac neurosis/DaCosta’s syndrome
y Herpes Zoster

Question 2

Symptoms of

1. Myocardial Ischaemia
2. Aortic Dissection
3. Pericarditis
4. Pleuritic Pain
   5.Peptic pain
5. Muskuloskeletal pain

Answer 2

1. Myocardial Ischaemia
   a) Quality of Pain
   — Crushing,
   —tight,
   —heavy or
   — band-like

b) Site of Pain
Central anterior chest

c) Radiation
To throat, jaw, arms or nowhere

d) Exacerbat- ing Factors
Exertion, anxiety, cold

e) Relieving Factors
Rest, nitrates

f) Associated features
Nausea, vomiting, sweating, dyspnoea, shock

2. Aortic Dissection
   a) Quality of Pain
   — tearing

b) site of pain
— central

c) Radiation
— back

d) Exacerbat- ing Factors
— None

e) Relieving Factors
— None

f) Associated features
— Shock,
— cyanosis,
— sweating,
— right & left arm BP difference,
— new aortic regurgitation murmur

3. Pericarditis

a) Quality of Pain
— Sharp

b) Site of Pain
— Central anterior

c) Radiation
— Usually no radiation

d) Exacerbat- ing Factors
— lying supine,

e) Relieving Factors
— Sitting forward

f) Associated features
— Fever,
— recent viral illness

4. Pleuritic Pain

a) Quality of Pain
— Sharp

b) Site of Pain
— Anywhere in chest

c) Radiation
— Usually none

d) Exacerbat- ing Factors
— Exacerbated by inspira- tion,
— coughin,

e) Relieving Factors
— None

f) Associated features
— Cough,
— haemoptysis,
— dyspnoea and
— shock (in massive PE)

5.Peptic pain

a) Quality of Pain
— burning
b) Site of Pain
— central

c) Radiation
— to the throat occasionally

d) Exacerbat- ing Factors
— spicy food
— alcohol

e) Relieving Factors
— Bland food and antacids

f) Associated features
— bloating
— wind

6. Muskuloskeletal pain

a) Quality of Pain
— Sharp or dull

b) Site of Pain
— Anywhere on chest wall

c) Radiation
— To arms or
— around chest to back

d) Exacerbat- ing Factors
— Pressure on chest or
— moving neck

e) Relieving Factors
— Restriction of move- ment

f) Associated features
— Patient looks well