Chest Pain ❤️‍🔥

✍️Add to Tasks

🧠 Differential Diagnosis

  • Acute Coronary Syndrome (ACS) – Most important to rule out. May present atypically (nausea, dyspnoea, back pain). Risk factors: age, smoking, HTN, DM, IHD.
  • Aortic Dissection – Sudden tearing chest/back pain, often interscapular. Pulse deficits or BP difference. Urgent CT-A.
  • Pulmonary Embolism (PE) – Sudden pleuritic pain, tachypnoea, tachycardia, hypoxia. Consider Wells Score/D-dimer/CTPA.
  • Pericarditis – Sharp or dull pain, often relieved by sitting forward. May have pericardial rub or ECG changes (diffuse ST elevation).
  • Gastro-oesophageal – GORD, oesophageal spasm. Consider if burning or post-prandial.
  • Pneumothorax – Especially in COPD patients or post-central line. Absent breath sounds, hyperresonance.
  • Other causes – Anxiety, costochondritis, musculoskeletal, herpes zoster (prior to rash).

📞 When Called

  • Ask for current vitals, oxygen saturation, and pain level.
  • Check if ECG has been done — request one if not.
  • Ask about history of IHD, current meds
  • Find out if the patient has IV access.
  • Review sign-out or medical notes for relevant background.

🧾 History

  • Onset, duration, character of pain (sharp, pressure, burning?)
  • Any radiation (jaw, left arm, back)?
  • Associated symptoms: sweating, dyspnoea, nausea, syncope?
  • Previous episodes? Exertion-induced?
  • Cardiac risk factors: HTN, DM, smoking, FHx, prior MI?

🩺 Examination

  • General appearance: distress, pallor, diaphoresis?
  • Vital signs: HR, BP (both arms if suspect dissection), RR, SpO₂, Temp
  • Heart sounds, JVP, chest auscultation (creps, wheeze, rub)
  • Peripheral pulses (radio-femoral delay, pulse deficit)
  • Check for signs of DVT if suspect PE

🔍 Investigations

  • 12-lead ECG – compare with previous if possible.
  • Bloods: Troponin, FBC, U&Es, CRP, Coag, D-dimer (if indicated)
  • CXR – rule out pneumothorax, heart failure, mediastinal widening.
  • CTPA or CT Aorta depending on suspicion.
  • ABG if hypoxic or unwell

💊 Initial Management

  • STEMI: Call STEMI team immediately. Give Aspirin 300mg chewed, plus P2Y12 inhibitor (e.g. Ticagrelor 180mg). Oxygen only if SpO₂ <90%. Nitrates and morphine if needed (avoid in hypotension/RV infarct).
  • NSTEMI/ACS: Cardiology referral, dual antiplatelets (e.g. Aspirin + Ticagrelor), LMWH, beta-blockers, statins.
  • PE: Anticoagulate (LMWH/DOAC) unless contraindicated. Thrombolysis if massive PE.
  • Pneumothorax: Needle decompression if tension PTX. Otherwise, CXR-guided management.
  • Pericarditis: NSAIDs, colchicine if no contraindications.
  • Provide O₂ if SpO₂ <92%. Reassess regularly.

🔗 External Resources

    Note Template

    Ready-to-use clinical note structure

    🕒 21 / 11 / 2025 — 03:11

ATRP re: chest pain
Patient: [age] [sex]
Admission Dx: [reason for admission]
PMHx: [CAD, hypertension, hyperlipidaemia, smoking]

🧾 Hx:
• Onset, character, radiation and duration
• Associated symptoms: dyspnoea, diaphoresis, nausea
• Exacerbating and relieving factors
• Previous episodes or cardiac history

🩺 Exam:
• Vitals: HR __ BP __ RR __ Temp __ SpO₂ __
• Cardiovascular exam: heart sounds, JVP
• Respiratory exam: breath sounds, crepitations
• Signs of heart failure or shock

📋 Impression:
Likely cause: [ACS / angina / PE / musculoskeletal / other]

📌 Plan:
• ECG and cardiac enzymes
• Oxygen if hypoxic
• Analgesia and nitrates if appropriate
• Antiplatelets and anticoagulation as indicated
• Admit for monitoring and further management

👤 [Your Name], [Role]
IMC: _______
    ✍️Add to Tasks