Chest Pain

Chest Pain

1. MI

   • C: prolonged >1/2hr, dull, central crushing pain or pressure
   • R: (Cadiac Ischaemia) to shoulder, either or both arms or neck/Jaw.
   • A: nausea, vomitting sweating

2. Dissecting aortic aneurysm

   • C: instantaeous, tearing
   • R: Interscapular, may be retrosternal
   • Unequal pulse between arms

3. Pericarditus

   • C: Sharp
   • E: relieved by leaning forward

4. Pulmonary Embolism

   • A: acute onset dyspnoea
   • Pleuritic chest pain

5. SOCRATES

6. Angina

   • C: Constricting
   • E: meals, relieved by GTN within minutes, exacerbated by Anemia
   • A: Caused by coronary artery disease, aortic stenosis, hypertrophic cardiomyopathy (HCM), paroxysmal supraventricular tachycardia (SVT)

7. Oesophageal Spasm/disease

   • C: constricing
   • E: food, lying flat, hot drinks, alcohol, relieved by GTN over a longer period of time, antiacids

8. Anxiety

   • C: constricting
   • E: cold, exercise, palpitations, emotion
   • A: dyspnoea, palpitations

9. Pleuritic

   • C: Sharp
   • A: dyspnoea
   • E: exacerbated by inspiration
   • Causes: Inflamation of the pleura from PULMONARY INFECTION, INFLAMMATION OR INFARCTION
   • 'Catch ones breath'
   • DD: MSK pain, fractured rib, sub-diaphragmatic pathology (e.g gallstones)

10. Cardiac Pain

    • A: dyspnoea
    • R: epigastric
    • E: cold, exercise, palpitations, emotion

11. Tietze's Syndrome

    • A: Tenderness
    • Self-limiting Costochondritis+/- costosternal joint swelling
    • Treated with NSAIDS, steroids
    • Causes: idiopathic, infection, Rheumatoid arthritis

12. PLAN

    • O2 mask
    • IV line if acutely ill
    • Analgesia
    • cardiac monitor
    • 12 lead ECG
    • CXR
    • ABG

13. TRAPS:

    • Aortic dissection
    • Zoster
    • Ruptured oesophagus
    • Cardiac tamponade
    • Opiate addiction

14. Dyspnoea

    • LVF, PE, Respiratory, anxiety
      • SOB at rest or on exertion?
      • Exercise tolerance
      • SOB in daily tasks
      • Episodic?
      • Triggered by lying flat?
      • LVF
        • Orthopnoea - number of pillows?
        • PND- waking up at night gasping for breath
        • Peripheral oedema
      • PE
        • Acute onset dysponea
        • Pleuritic chest pain
        • Ask about risk factor for DVT
          • increased age
          • the pill/synthetic oestrogen
          • Trauma
          • Surgery esp. pelvic/orthopaedic
          • Previous DVT
          • Obesity
          • cancer
          • Thrombophilia
          • Immobility

15. Palpitations

    • May be due to: ectopics, AF, SVT, VT, Thyrotoxicosis, anxiety
    • Ask: previous episodes, precipitating factors, duration, associated CP, dysponea, dizzy

16. Syncope

    • Cardic or CNS
      • Cardiac
        • CP
        • Palpitations
        • Dyspnoea
      • CNS
        • Aura
        • Headaches
        • Dysarthia
        • imb weakness
    • Vasovagal Faint
      • ilated pupils
      • Drop in pulse
    • Observer history
    • Limb jerking, tongue biting, urinary incontinence?
    • Recover: rapid, (arrhythmia) prolonged with drowsiness (seizure)