SOURCES OF NONSPECIFIC CHEST PAIN Flashcards

angina (coronary insufficiency)

myocardial infarction (MI)

mitral valve prolapse

pericarditis

dissecting aortic aneurysms

• A heavy ache especially in substernal region
• A squeezing sensation
• Pressure or tightness in the substernal area
• Pain radiating to the neck, jaws, arms, or shoulders
• Angina may be moderate to severe in intensity but usually lasts less than 15–20 minutes. It is often precipitated by physical exertion, emotional stress, cold weather, or consumption of a large meal, and is relieved by rest or nitrates.

Increased myocardial oxygen demand

Diminished blood supply to the heart

Coronary artery plaque disruption

Coronary artery plaque disruption

Coronary artery thrombus formation

Vasospasm within the coronary arteries

• Stable angina pectoris
• Unstable angina pectoris
• Prinzmetal's angina (or variant angina)

may be precipitated by physical activity, emotional stress, or eating a heavy meal. The pain associated with stable angina has similar characteristics (severity, duration, precipitating events) each time it occurs. Stable angina attacks usually last less than 5 minutes and are relieved by rest and/or nitroglycerin.

^age, HLD, HTN, DM, being a fatso, smoking

Coronary microvascular dysfunction (improper function of tiny blood vessels)

new onset angina

stable angina which becomes more frequent

rest angina

symptoms worsen in severity, duration, and quality

attacks may last as long as 30 minutes, and may or may not be relieved by rest or nitroglycerin

could be s/sx of MI

Variant angina may be severe in intensity, often occurs at rest during the early morning hours, and is relieved with nitroglycerin.

Chest pain that is associated with a change in cardiac biomarkers and evidence of ischemia

Myocardial infarction is due to the rupture of atherosclerotic plaque and subsequent thrombus formation. The pain associated with Type 1 myocardial infarction (MI) is similar to the pain associated with angina but is usually more severe.

pain is a heaviness like "an elephant sitting on my chest," pressure, burning, constriction, or squeezing. Other common clinical manifestations often associated with Type 1 MI pain include shortness of breath, sweating, weakness, nausea, vomiting, and severe anxiety.

Usually has a sudden onset

Lasts longer than 30 minutes

Is not relieved by rest

Is not relieved by single doses of sublingual nitroglycerin

unstable angina. The pain is new onset, is less than 30 minutes in duration, and is relieved by rest.

The pathophysiology of ACS includes atherosclerosis, vasospasm, and thrombosis, which results in myocardial ischemia.

pain associated with pericarditis usually begins over the sternum and may radiate to the back and subscapular area. Occasionally the pain radiates to the shoulders and arms and can be confused with the pain of angina or myocardial infarction. Likely to have a fever.

The pain is usually described as sharp, stabbing, and knifelike.

This type of pain can range from moderate to severe.

The pain may last anywhere from many hours to many days.

The pain is aggravated by deep breathing, and varies with position.

This type of pain is often relieved by sitting up and leaning forward.

Pericardial friction rub may be present.

usually located in the anterior portion of the chest and radiates to the thoracic area of the back.

Sudden, severe anterior chest pain, which may last for hours to days

The pain is described like "tearing," "ripping," or "knifelike."

The location of the pain shifts as the dissection extends.

The pain seems to be unrelated to any precipitating factors and is usually not relieved by any conventional measures.

Difference in systolic pressure between arms

Absent pulses

Paralysis or other neurological deficits

An early diastolic murmur of aortic insufficiency/regurgitation

Pulsus paradoxus

Stridor

Splitting of the aortic wall by blood entering through an internal tear or by interstitial hemorrhage

A raspy inhalation caused by a constricted airway

often no symptoms but can include:

An onset that is gradual and mild

Pain described as sharp or vague

Pain occurring in paroxysmal episodes, which may be brief or prolonged

Pain that is usually unrelated to exertion and unrelieved by sublingual nitroglycerin or rest

Rarely radiates to the jaw, back or arms

Pain is positional; decreased when lying down

May also include:

• Palpitations
• Dizziness
• Syncope related to dysrhythmias
• Dyspnea
• A late systolic or pansystolic murmur
• Fatigue or decreased exercise tolerance
• Anxiety
• Headaches and mood swings

Occurs briefly and transiently

A kind of murmur that occurs during the entire systole

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Sitting up and leaning forward

Vague substernal chest pain

To detect evolving signs of myocardial ischemia and infarction

• Visceral
• Somatic
• Cardiac
• Nociceptive

Pain in the chest region is mostly induced by mechanical, chemical, or thermal means, and is considered to be nociceptive.

Described as aching or heaviness and is generalized. The pain receptors in the viscera react to stretch, inflammation, and ischemia. Visceral pain originates in specific organs such as the heart, liver, bowels, or bladder. Examples include chest heaviness or crushing.

The pain is described as sharp, piercing, and specific to a local area. The pain is reproducible with palpation. An example includes costochondritis.

Pain is a sharp and localized pain in the chest region. It may be visceral and somatic or neither. It may also be referred pain. Examples include a patient with MI who only feels gastric fullness or heaviness in the chest.

Nociceptive pain arises from specific pain receptors and is classified as somatic or visceral in nature.

Location

Where is the pain radiating?

Intensity

How would you describe the pain on a pain scale?

Aggravating and alleviating factors

What makes the pain better or worse?

• Any history of angina or MI
• The patient's age (Risk increases with age. MI is more common in men after age 40 and women after age 50.)
• Additional risk factors (smoking, hypertension, hyperlipidemia, or diabetes)

Fatigue, tiredness, and sleep disturbances may be symptoms of coronary artery disease in women

aching or heaviness

crushing type pain

sharp and piercing

costochondritis

somatic or visceral pain

mechanical, thermal, or chemical

visceral and cardiac component

sharp localized pain

• Pulmonary embolism
• Pulmonary hypertension
• Spontaneous pneumothorax
• Pneumonia with pleurisy

Not often causes pain. If so, usually described as a sharp, pleuritic pain. However, it may also be described as a dull, heavy sensation, that mimics anginal pain.

acute onset, aggravated by coughing or deep breathing

Dyspnea (the most common symptom)

Tachycardia

Tachypnea (the most frequent sign)

Anxiousness, restlessness, feeling "terrible"

Syncope

Hypotension

Low-grade fever

Elevated jugular venous pressure

Pleural rub

Hemoptysis

A clot or other blockage that is carried by the bloodstream from its point of origin to a smaller blood vessel where it obstructs the circulation

Coughing up blood or blood in the sputum

In the early stages, symptoms may be absent or subtle. As the disease progresses, shortness of breath is the most common symptom. Other symptoms include:

• Lightheadedness
• Fatigue
• Chest pain

requires a battery of diagnostic testing to differentiate it from other causes of dyspnea.

Chest pain that is associated with spontaneous pneumothorax and is unilateral, located on the affected side.

• Dull, sharp, or stabbing pain that is very localized
• sudden onset and often lasts many hours
• Increases in intensity when taking deep breaths or coughing
• dyspnea, hyperresonance over the affected area, and decreased breath and voice sounds over the affected lung.
• Dx is CXR

An increased resonance produced when the area is percussed

inflammation of the pleura, the membrane that surrounds the lungs. Pleurisy is a potential complication of pneumonia.

Usually described as moderate in severity. The pain is worsened with deep inspiration or coughing and is usually relieved by holding your breath or applying pressure over the localized area of pain.

Dyspnea

Cough productive of bloody or foul-smelling sputum

Dull-to-flat percussion over areas of consolidation

Fever

Bronchial breathing patterns

Crackles

Pleural friction rub may be heard.

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