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Flashcards in Chest Pain Deck (18)
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1
Q

Common cardiac causes of chest pain

A

Myocardial ischaemia (angina) or infarction (MI)

2
Q

Typical features of cardiac chest pain

A

Central
Tight or heavy
May radiate to jaw or left arm

3
Q

Vascular causes of chest pain

A

AORTIC DISSECTION = MEDICAL EMERGENCY

4
Q

Typical features of vascular chest pain

A

Very sudden onset

Pain radiates to the back

5
Q

Common pleuropericardial causes of chest pain

A
Pericarditis (+/- myocarditis)
Infective pleurisy
Pneumothorax
Pneumonia
Autoimmune
Mesothelioma
Metastatic tumour
6
Q

Typical features of pleuropericardial chest pain

A

Pleuritic pain - sharp/stabbing, worse on deep inhalation/coughing.
- Pericarditis - worse on lying down
- Pneumothorax - sudden onset, ass w/ dyspnoea
- Pneumonia - ass w/ fever & dyspnoea
Non-pleuritic
- Mesothelioma - severe & constant
- Metastatic tumour - severe & constant, localised

7
Q

Common chest wall causes of chest pain

A
Persistent cough
Muscular Strain
Thoracic zoster
Rib fracture
Rib tumour (primary or metastatic)
Thoracic nerve compression/infiltration
8
Q

Typical features of chest wall pain

A
  • Persistent cough - tender chest wall, worse with movement
  • Muscular strain - as above
  • Thoracic zoster - severe, precedes rash, follows nerve root distribution
  • Rib fracture - history of trauma, localised tenderness
  • Rib tumour - constant, severe, localised
  • Thoracic nerve compression/infiltration - follows nerve root distribution
9
Q

Common gastrointestinal causes of chest pain

A
  • GORD

- Diffuse oesophageal spasm

10
Q

Typical features of GIT chest pain

A
  • GORD - not related to exertion, may be worse when patient lies down; common.
  • Diffuse oesophageal spasm - relieved by swallowing
11
Q

Common airway causes of chest pain

A
  • Tracheitis
  • Central bronchial carcinoma
  • Inhaled foreign body
12
Q

Typical features of airway-related chest pain

A

Pain in throat & pain on breathing

13
Q

Features of chest pain that favour a diagnosis of angina

A
  • Tight/heavy
  • Moderate pain/discomfort (MI is severe)
  • No sweating
  • Onset predictable with exertion
  • Relieved by rest & rapid relief with nitrates
  • Mild/no anxiety (high anxiety in MI)
  • No nausea and vomiting (MI)
14
Q

Features of chest pain that favour a diagnosis of MI

A
  • Tight/heavy (crushing)
  • Subacute onset (minutes)
  • Anxiety (feeling of impending doom)
  • Onset (can be) at rest
  • Sweating
  • Nausea and/or vomiting
  • Severe pain
  • No relief with nitrates
15
Q

Features of chest pain that favour a diagnosis of aortic dissection

A
  • Instantaneous onset
  • Pain radiates to back
  • Very severe pain with a tearing quality
16
Q

Features of chest pain that favour a diagnosis of chest wall pathology

A
  • Pain is positional
  • Often worse at rest
  • Prolonged & localised pain
  • Chest wall itself is tender
17
Q

Features of chest pain that favour a diagnosis of pericarditis or pleurisy

A
  • Sharp or stabbing character
  • Not exertional/present at rest
  • Worse when supine (pericarditis)
  • Worse with respiration (esp. deep inspiration)
  • Presence of pericardial or pleural rub
  • Unaffected by nitrates
18
Q

Features of chest pain that favour a diagnosis of oesophageal (acid) reflux

A
  • Burning character
  • Present at rest (non-exertional)
  • Onset may be when supine or when bending over, after meals etc.
  • Unaffected by respiration
  • Unaffected by nitrates (UNLESS there is also oesophageal spasm)