EMQ practice - Chest pain

Chest pain

• 63 year old man, sudden-onset tearing chest pain radiatiing to the back, Hx HBP
• Aortic dissection
• Dissection can interrupt flow to the coronary arteries resulting in myocardial ischaemia
• Stanford classification
• A involves ascending aorta - Surgery
• B does not - Aggressive reduction in blood pressure
• 40 year old woman, sudden-onset dyspnoea at rest following hip replacement surgery, tachycardic with right axis deviation
• Pulmonary embolus
• Hypoxia, pyrexia and haemoptysis
• Look out for recent surgery and immobility as risk factors
• 60 year old man, central crushing chest pain, pain relieved by rest, no ECG changes
• Angina
• Pain brought on my exercise but also cold weather and emotion
• 21 year old high jumper, acute-onset dyspnoea and right-sided pleuritic chest pain. Increased resonance and reduced expansion on the right side
• Pneumothorax
• Tall thin young men at risk
• Trachea deviated away in tension pneumothorax
• Do not do chest radiograph because it may delay emergency treatment
• COPD patients also at risk because of bullae rupture
• 23 year old woman, localised left-sided chest pain that is exacerbated by coughing and is particularly painful on light pressure to that area, with pain relieved by aspirin
• Costochondritis
• Second rib frequently affected