Common cardiac causes of chest pain
Myocardial ischaemia (angina) or infarction (MI)
Typical features of cardiac chest pain
Central
Tight or heavy
May radiate to jaw or left arm
Vascular causes of chest pain
AORTIC DISSECTION = MEDICAL EMERGENCY
Typical features of vascular chest pain
Very sudden onset
Pain radiates to the back
Common pleuropericardial causes of chest pain
Pericarditis (+/- myocarditis) Infective pleurisy Pneumothorax Pneumonia Autoimmune Mesothelioma Metastatic tumour
Typical features of pleuropericardial chest pain
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
Common chest wall causes of chest pain
Persistent cough Muscular Strain Thoracic zoster Rib fracture Rib tumour (primary or metastatic) Thoracic nerve compression/infiltration
Typical features of chest wall pain
- 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
Common gastrointestinal causes of chest pain
- GORD
- Diffuse oesophageal spasm
Typical features of GIT chest pain
- GORD - not related to exertion, may be worse when patient lies down; common.
- Diffuse oesophageal spasm - relieved by swallowing
Common airway causes of chest pain
- Tracheitis
- Central bronchial carcinoma
- Inhaled foreign body
Typical features of airway-related chest pain
Pain in throat & pain on breathing
Features of chest pain that favour a diagnosis of angina
- 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)
Features of chest pain that favour a diagnosis of MI
- 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
Features of chest pain that favour a diagnosis of aortic dissection
- Instantaneous onset
- Pain radiates to back
- Very severe pain with a tearing quality
Features of chest pain that favour a diagnosis of chest wall pathology
- Pain is positional
- Often worse at rest
- Prolonged & localised pain
- Chest wall itself is tender
Features of chest pain that favour a diagnosis of pericarditis or pleurisy
- 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
Features of chest pain that favour a diagnosis of oesophageal (acid) reflux
- 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)