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Approach to

chest pain

Neeshanthi Sundareson 012012100240


Athina Nasyrah Abdullah 012012100001
Devina Devi Gunalan 012012100023
Pathmashalini Tiagarasu 012012100031
Clare Musih
012012100068

Angina
Site
: retrosternal
Onset
: 1-2 minutes
Character
: constricting, heavy
Radiation
: arms, neck, epigastrium
Associated symptoms: breathlessness
Timing
: 2-10 minutes
Exacerbation/ relieving factor: triggered by emotions,
exertion, cold. Relieved by rest, nitrates
Severity
: mild to moderate

Myocardial infarction
Site
: retrosternal
Onset
: rapid over few minutes
Character
:constricting, heavy
Radiation
: arms, neck, epigastrium
Associated symptoms: sweating, nausea, vomiting,
breathlessness, feeling of impending death
Timing
: prolonged
Exacerbation/ relieving factor: stress, exercise usually
spontaneously and not relieved by rest or nitrates
Severity
: usually severe

Aortic dissection

Site
: retrosternal / interscapular
Onset
: very sudden
Character
: tearing, ripping
Radiation
: back and between shoulders
Associated symptoms : sweating, syncope, focal
neurological signs, signs of limb ischemic, mesenteric
ischemic
Timing
: prolonged
Exacerbation/ relieving factor: spontaneous, no
manoeuvres relieve pain
Severity
: very severe

Pericardial pain

Site
: retrosternal or left sided
Onset
: gradual
Character
: sharp stabbing, pleuritic
Radiation
: left shoulder, back
Associated symptoms : flu like prodrome, breathlessness,
fever
Timing
: gradual onset, variable duration
Exacerbation/ relieving factor: pleuritic, sitting up, lying
down. Relieved by NSAIDs
Severity
: severe

Oesophageal pain

Site
: retrosternal or epigastric
Onset
: 1-2 minutes, can be sudden
Character
: gripping, tight or burning
Radiation
: back, arms
Associated symptoms : heartburn, acid reflux
Timing
: night time, variable duration
Exacerbation/ relieving factor: lying flat, food and not
relieved by rest n nitrates
Severity
: usually mild, can mimic myocardial
infarction

The end.
Thank you