Chest pain symptom analysis

Myocardial infarction/ACS:

MI/ACS

- STEMI

- NSTEMI

- unstable angina

Age, male, family history, smoking, hypertension, DM, hyperlipidaemia, obesity, sedentary lifestyle, cocaine use

Acute crushing central dull chest pain >20mins

Radiation to shoulder, arms, neck or jaw

Associated with nausea, sweatiness, dyspnoea, palpitations, pallor

Silent MIs can have epigastric pain, vomiting

Ruling out ACS through signs and symptoms has low sensitivity/specificity = low threshold for referral

Stable angina:

- Constricting pain/heavy discomfort to the chest, jaw, neck, shoulders or arms

- symptoms brought on by exertion

- relieved IMMEDIATELY (within 5 mins) with rest or GTN

- Dyspnoea, nausea, sweatiness, faintness

Stable angina

Pericarditis

Pericarditis

Men, previous MIs, previous kidney failure

Central chest pain

Sharp/stabbing

Worse on inspiration or lying flat

Relieved by leaning forward

Fever

Myocarditis

Diabetics, HIV/AIDS, 20-40 year olds

ACS-like symptoms

Heart failure symptoms e.g. breathlessness, peripheral oedema

Palpitations, tachycardia

Fever, body aches

Aortic dissection

Older men

Instant tearing pain, interscapular, can be retrosternal

Odd neurological symptoms

Aortic dissection

Pneumonia

Long hospital stays, elderly, immunosuppressed, stroke patients, myasthenia, bulbar palsies, reduced consciousness leading to aspiration

Pleuritic chest pain

Cough with purulent sputum

Fever, rigors, malaise, anorexia, dyspnoea, haemoptysis

Pulmonary embolism

Rcent surgery (abdo/pelvic or hip/knee replacement), prolonged bed rest, leg fracture, thrombophilia, malignancy, pregnancy, women on contraceptive pill, previous PE

Pleuritic chest pain

Acute breathlessness, haemoptysis, dizziness, syncope

Pulmonary embolism

Pneumothorax

Young thin mean, asthmatics, COPD, CF, pneumonia

Mild = asymptomatic

Serious = sudden onset pleuritic chest pain, dyspnoea, sudden asthma or COPD deterioration

Lung cancer

Cigarette smokers, asbestos exposure

Chest pain, cough, haemoptysis, dyspnoea, lethargy, anorexia, sudden weight loss

Lung cancer

GORD

Obesity, smoking, alcoholics, pregnancy

Heartburn- burning retrosternal pain

Brought on by food, lying flat, stooping, hot drinks, alcohol

Relieved by antacids

Belching, acid or bile regurgitation, increased salivation.

Chronic cough, laryngitis, painful swallowing, sore throat

Oesophageal spasm

Older people, people with GORD

Constricting chest pain

Odynophagia, intermittent dysphagia

Brought on by food, lying flat, hot drinks, alcohol

Oesophageal spasm

Peptic ulceration

Duodenal: COMMON, H.Pylori, NSAIDS, steroids, SSRIs, smoking, blood group O

Gastric: LESS COMMON, elderly, H.Pylori, smoking, NSAIDS, stress on body e.g. surgery or burns

Epigastric pain which can also present in chest. Tender epigastrium.

Can appear as retrosternal pain (heartburn)

Worse with hunger, specific foods, specific times of day.

Fullness after meals

Weight loss

ALARM symptoms

Peptic ulceration

Pancreatitis

Alcoholics, smokers, autoimmune conditions, people with hyperlipidaemia, hypercalcaemia, had an ERCP, taking steroids, history of CF, history of stones- GET SMASHED

Epigastric pain radiating to the back (acute would be gradual or severe would be sudden)

Relieved by sitting forward.

Vomiting, bloating, steatorrhoea, weight loss, brittle diabetes (swinging between extremes)

Jaundice

Biliary colic

Smokers, high parity, obesity

RUQ intermittent pain which radiates to the back.

Can present as pleuritic pain.

With or without jaundice

Muscular strain

Doing an activity that caused it

Pleuritic chest pain

Muscular strain

Costochondritis (easily missed, also called Tietze's syndrome)

Costochondritis

Older people

LOCALISED pain and tenderness at costosternal junction (2nd rib most commonly affected)

Worse with moving, coughing, sneezing

Contusions

Active children (caused by a direct blow to the body causing damage to skin and deeper tissues)

Pain and swelling

Discolouration

Tightness in the affected muscle and stiffness in the joint

Panic attacks/anxiety

Women, family history, following major life stress

Constricting chest pain

Dyspnoea, hyperventilation, tremor, swating, tachycardia, paraesthesiae, lightheadedness

Associated with cold, exercise, palpitations, emotions

Panic attacks