421 – Cardiac Review (Chest Pain) Cardiovascular (Ischemic) Angina: Stable (no change in pain pattern within last 60 days) Prinzmetal or variant angina ACS (UA, MI) - Spasm near blockage Cardiovascular (Non-Ischemic) Pericarditis Mitral Valve Prolapse Common Pain Description - Pressure-like discomfort - Tightness, squeezing, burning, heaviness - Lasts 3-5 mins - Precipitated by activity & resolves w/ rest - Pressure-like discomfort - Often occurs at rest and early morning hours - Heaviness, vise-like, squeezing, crushing, tightness, vague, burning, constricting, or pressure - Poorly localized pain lasting 20-30 mins to hours - Doesn’t resolve w/ rest Location/Radiation - Generalized sub or retrosternal - Can radiate to teeth, jaw, neck, one or both arms or shoulders - May be no pain and only associated symptoms - Indigestion-like feeling - N&V - Dizziness - Flushing - Perspiration - Palpitations - Dyspnea Common Pain Description - Sudden sharp and stabbing pain - Relieved by sitting or leaning forward - Worsens w/ lying down or inspiration - Sharp pain not associated w/ activity Location/Radiation Possible Associated Symptoms - Dry cough - Muscle and joint aches - Fever - Generalized sub or retrosternal - Can radiate to teeth, jaw, neck, one or both arms or shoulders - May be no pain and only associated symptoms - Retrosternal - Can radiate to jaw, neck, L arm or shoulder - Substernal - Can radiate to trapezius muscle region - CP w/o radiation Possible Associated Symptoms - Diaphoresis - N&V - Dyspnea - Palpitations - Syncope - Feelings of syncope - Fatigue - Lightheadedness - Dyspnea - Irregular rhythm - Palpitations - Exercise intolerance Aortic Dissection Pulmonary HTN (Secondary) Pulmonary PE Pneumonia - Sudden severe pain w/ change in location and/or tearing sensation - Lasts for hours - Cardiac-like CP w/ exertion - Ant. chest pain - Radiation to neck, jaw, or intrscapular region of back Common Pain Description - Sharp, stabbing pain - Worsens w/ deep breaths - Sharp or stabbing pain associated w/ cough Location/Radiation - Chest region Possible Associated Symptoms - Pain can be in chest, - Dyspnea back, shoulder or - Hemoptysis upper abd. - Cough - Generalized to one - Cough side of chest - Fever - Can have upper - Dyspnea abd. pain - Chills - Sputum - Myalgia - Malaise - Lateral region of - Acute dyspnea chest - Cough - Can have referred pain to shoulder Pneumothorax - Acute/sudden & sharp GI Common Pain Description - Crushing CP Location/Radiation - Sudden onset of pain - Crescendos - Can last up to 20 mins - Usually after eating fatty meal - Epigastric or RUQ pain - Can radiate to right intrascapular region, shoulder or back Esophageal Spasm Cholecystitis - Mental status changes - Limb pain - Weakness - Dyspnea - Dyspnea - Lower extremity edema - Fatigue - Substernal Possible Associated Symptoms - Dysphagia - Sensation of object in throat or esophagus - N&V - Fever - Anorexia Pancreatitis - Sudden, dull, boring, steady pain - Unrelieved by lying supine - Leaning forward or fetal position may relieve - Epigastric or periumbilical pain - Radiated to back - N&V - Anorexia - Sometimes diarrhea Dermatological Common Pain Description - Unilateral - Burning - Borelike pain Location/Radiation Possible Associated Symptoms - Tingling - Itching - Burning Herpes Zoster Musculoskeletal/Neuro Common Pain Description Costochondritis - Sharp - Pleuritic-type pain - Worsens w/ deep breathing, palpitation or movement Chest Wall Muscle Strain Notes: - Sharp pain w/ moving, stretching, or pushing movements of the arms - Palpitation of area reproduces pain - Chest region in dermatome distribution Location/Radiation - Area from 2nd through 5th intercostal space - Can radiate to arm depending on where initial inflammation occurs - Area around the strained muscles, sternum or ribs Possible Associated Symptoms - Chest tightness - Warmth at area of pain - Muscle spasm - Crepitation - Swelling - Loss of strength Pericarditis – Beck’s Triad Pneumothorax – sudden onset, no breath sounds/diminished entry on one side To determine if GI cause, give viscous lidocaine and amogel (antacids) Cholecystitis – rebound tenderness (Positive Murphy Sign) Pancreatitis – painful, food precipitates symptoms Costochondritis – can pinpoint, worse w/ palpation Aortic valve stenosis common cause of murmurs S1 = tricuspid and mitral valves closing S2 = aortic and pulmonic valves closing Noise between S1 and S2 = systolic murmur (lub shhhh dub)
