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Chest Pain
Chest Pain Differentials
| Question | Answer |
|---|---|
| Angina pectoris: What is the process? | Temporary myocardial ischemia, usually secondary to coronary atherosclerosis |
| Angina pectoris: Location? | retrosternal or across the anterior chest, sometimes radiating to the shoulders, arms neck, lower jaw, or upper abdomen |
| Angina pectoris: What is the quality? | Pressing, squeezing, tight, heavy, occasionally, burning |
| Angina pectoris: What is the severity? | mild to moderate, sometimes perceived discomfort vs pain. Usually 1-3 min but up to 10 min. Prolong episodes up to 20 min |
| Angina pectoris: Aggravating factors? | exertion, especially in the cold, meals, emotional stress. May occur at rest |
| Angina pectoris: Relieving factors? | rest, nitroglycerin |
| Angina pectoris: Associated symptoms? | sometimes dyspnea, nausea, sweating |
| Myocardial infarction: What is the process? | Prolong myocardial ischemia, resulting in irreversible muscle damage or necrosis |
| Myocardial infarction: Location and quality? | Same as angina |
| Myocardial infarction: Quality? | often but not always a severe pain, may last 20 min to several hours |
| Myocardial infarction: Associated symptoms? | dyspnea |
| Pericarditis: What is the process? | Irritation of the parietal pleura adjacent to the pericardium |
| Pericarditis: Location? | retrosternal or left precordial, may radiate to the tip of the shoulder |
| Pericarditis: What is the quality? | severe, persistent, sharp knifelike type pain |
| Pericarditis: Factors that aggravate? | breathing, changing positions, cough, lying down, sometimes swallowing |
| Pericarditis: Factors that relieve? | sitting forward may relieve it |
| Pericarditis: Associated symptoms? | seen in autoimmune disorders, post;myocardial infarction, viral infection, chest irradiation |
| Dissecting aneurysm: What is the process? | a splitting within the layers of the aortic wall, allowing passage of blood to dissect a channel |
| Dissecting aneurysm: Location? | anterior chest, radiating to the neck, back or abdomen, dyspnea and sometimes loss of consciousness |
| Dissecting aneurysm: Quality? | very severe, abrupt onset ripping, tearing type pain that peaks early and persists for hours or more |
| Dissecting aneurysm: Factors that aggravate? | hypertension |
| Dissecting aneurysm: Associated symptoms? | if thoracic, hoarseness, dysphagia, also syncope, hemiplegia, paraplegia |
| Tracheobronchitis: What is the process? | inflammation of trachea and large bronchi |
| Tracheobronchitis: Location? | upper sternal or on either side of the sternum |
| Tracheobronchitis: Quality? | mild and moderate burning |
| Tracheobroncnitis: Factors that aggravate? | coughing, it's also an associated symptom |
| Tracheobronchitis: Factors that relieve? | lying on the involved side may relieve the pain |
| Pleuritic pain: What is the process? | inflammation of the parietal pleura, as in pleurisy, pneumonia, pulmonary infarction, or neoplasm |
| Pleuritic pain: Location? | over the chest overlying the , sharp, knifelike, severe, persistent |
| Pleuritic Pain: Factors that aggravate? | deep inspiration, coughing, movements of the trunk |
| Reflux esophagitis: What is the process? | inflammation of the esophageal mucosa by reflux of gastric acid |
| Reflux esophagitis: Location? | retrosternal, may radiate to the back |
| Reflux esophagitis: Quality? | mild to severe, burning, may be squeezing |
| Reflux esophagitis: Factors that aggravate? | large meal; bending over; lying down |
| Reflux esophagitis: Factors that relieve? | antacids, sometimes belching |
| Reflux esophagitis: Associated symptoms? | sometimes regurgitation, dysphagia |
| Diffuse Esophageal Spasm: What is the process? | motor dysfunction of the esophageal muscle |
| Diffuse Esophageal Spasm: Location? | Retrosternal, may radiate to the back, arms and jaw |
| Diffuse Esophageal Spasm: Quality? | mild to severe squeezing pain that varies in timing |
| Diffuse Esophageal Spasm: Factors that aggravate? | swallowing of food or cold liquid, emotional distress |
| Diffuse Esophageal Spasm: Factors that relieve? | sometimes nitroglycerin |
| Diffuse Esophageal Spasm: Associated symptom? | dysphagia |
| Chest wall pain/Costochondritis: What is the process? | it's an inflammatory process but usually has no definite cause. Repeated minor trauma to the chest wall, overuse of the arms, or viral respiratory infections can cause pain |
| Chest wall pain/Costochondritis: Location? | often below the left breast or along the costal cartilages |
| Chest wall pain/Costochondritis: Quality? | stabbing, sticking, or dull aching pain that varies in severity and is fleeting to hours and days |
| Chest wall pain/Costochondritis: Factors that aggravate? | movement of chest, trunk, arms |
| Chest wall pain/Costochondritis: Associated symptom? | local tenderness |
| Anxiety: What is the process? | through mechanisms that directly affect coronary vasculature. Both autonomic activation and hyperventilation (via alkalosis) can lead to coronary artery spasm |
| Anxiety: Location? | precordial, below the left breast of across the anterior chest |
| Anxiety: Quality? | stabbing, sticking, or dull aching pain that varies in severity and is fleeting to hours and days, same as with chest wall pain |
| Anxiety: Factors that aggravate? | may follow effort, emotional stress |
| Anxiety: Associated symptoms? | breathlessness, palpitations, weakness, anxiety |
Created by:
cljohnson2000
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