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What are common causes of cardiac-related chest pain?
Angina, myocardial infarction (MI), pericarditis, endocarditis, mitral valve prolapse.
What signs indicate the presence of cardiac-related chest pain?
Nausea, vomiting, diaphoresis, dyspnea, fatigue, pallor, syncope, heart palpitations, irregular heartbeat, and peripheral edema.
Describe the pain characteristics associated with cardiac-related chest pain.
Chest pain may be described as 'pressure', 'squeezing', 'heaviness', or 'burning'; intensity can vary, and irritability may be gradual or sudden.
What are the typical referral patterns for cardiac pain?
Pain may refer to the jaw, neck, chest, shoulder, arm (especially the left), thoracolumbar region, and abdomen.
3 P’s for cardiac events
pleuritic pain (pain with respiratory movements), palpation pain, pain with changes in position
What is the likelihood of cardiac involvement based on the presence of the 3 P's?
If only pleuritic pain is present, likelihood of cardiac involvement is 5-7%; if 2 P's present, drops to 2%; and if all 3 are present, drops to 1%.
What questions should be asked when suspecting cardiac involvement?
Questions include difficulty breathing, increased chest pain with exertion, heart palpitations, episodes of syncope, and excessive fatigue.
What are key indicators for immediate medical attention when suspecting cardiac issues?
Sudden increase and longer duration of chest pain not relieved by rest, position change, or nitroglycerin; or other significant associated symptoms.
Symptoms of a cardiac event that mimic musculoskeletal conditions
jaw, neck, shoulder, arm, back pain, myalgias, muscle fatigue or atrophy, general weakness, poor exercise tolerance
What are common pulmonary conditions that may present with upper quarter pain?
Tracheobronchial pain, pleurisy/pleuritis, pulmonary embolism, pneumothorax.
Symptoms of a pneumothorax
shortness of breath, dry cough, shallow breaths, acute onset sharp chest pain, referred pain to the ipsilateral shoulder and upper trap, drops in BP, more pain in recumbent position
How is pneumothorax defined?
A condition where air leaks into the space between the lung and chest wall, causing lung collapse.
What are the signs and symptoms of a pulmonary embolism?
Signs include possibly no symptoms, dyspnea, pleuritic chest pain, tachypnea, persistent cough, tachycardia, palpitations, anxiety, and may include hemoptysis.
Risk factors of pulmonary embolism
history of DVT, history of abdominal or pelvic surgery, TKA/THA, lower extremity fractures, pregnancy, older female, COPD, congestive heart failure, oral contraceptives
Describe the simplified Wells criteria for assessing pulmonary embolism risk.
Risk scoring based on clinical signs and symptoms of DVT, absence of alternative diagnosis, heart rate, immobilization history, previous DVT/PE, hemoptysis, and malignancy.
What are recommended screening questions for pulmonary conditions?
Questions about shoulder pain worsening with cough or deep breath, color of sputum, effects of lying down on shoulder pain, and recent shortness of breath.
Signs of a pulmonary event
sharp localized pain that is aggravated by breathing coughing or sneezing, pain improves with upright position, pain improves by lying on involved side
Describe tracheobronchial pain
pain referred upper and/or lateral sternum to points corresponding to major affected airways, typically on ipsilateral side
Symptoms of Pleurisy
chest pain, increased pain with lying down, cough, dyspnea, tachypnea, fever/chills, referred neck or shoulder pain, sharp pains become dull aches
