{"id":76,"date":"2017-03-23T07:34:30","date_gmt":"2017-03-23T07:34:30","guid":{"rendered":"http:\/\/papergp.com\/index.php\/chest-pain\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"chest-pain","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/cardiovascular\/chest-pain\/","title":{"rendered":"Chest pain"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4><strong>Differential diagnosis<\/strong><\/h4>\n<ul>\n<li>Cardiovascular\n<ul>\n<li>Stable angina\n<ul>\n<li>Typical for patient<\/li>\n<li>Constricting discomfort on exertion<\/li>\n<li>Resolves at rest\/GTN within 5 minutes<\/li>\n<\/ul>\n<\/li>\n<li>ACS\n<ul>\n<li>Pain at rest<\/li>\n<li>Increasing in frequency<\/li>\n<li>Nausea, sweats, lightheadedness<\/li>\n<li>Radiation to left arm\/jaw<\/li>\n<li>CV risk factors<\/li>\n<li>Duration &gt; 15 minutes<\/li>\n<\/ul>\n<\/li>\n<li>Pericarditis\n<ul>\n<li>Worse on inspiration<\/li>\n<li>Relieved by sitting forward<\/li>\n<li>Fever<\/li>\n<li>Pericardial rub<\/li>\n<\/ul>\n<\/li>\n<li>Acute thoracic dissection\n<ul>\n<li>Radiates to back<\/li>\n<li>Inequal pulses\/BP in arms<\/li>\n<li>Early diastolic murmur<\/li>\n<li>Uncontrolled BP<\/li>\n<\/ul>\n<\/li>\n<li>Arrhythmia\n<ul>\n<li>Palpitations<\/li>\n<li>Lightheadedness<\/li>\n<li>Breathlessness<\/li>\n<\/ul>\n<\/li>\n<li>Aortic stenosis\n<ul>\n<li>Ejection systolic murmur<\/li>\n<li>LVH on ECG<\/li>\n<li>Breathlessness<\/li>\n<li>Syncope<\/li>\n<\/ul>\n<\/li>\n<li>HOCM\n<ul>\n<li>FH cardiomyopathy<\/li>\n<li>Sickle cell disease<\/li>\n<\/ul>\n<\/li>\n<li>CCF\n<ul>\n<li>Ankle swelling<\/li>\n<li>Orthopnoea<\/li>\n<li>PND<\/li>\n<li>Breathlessness<\/li>\n<li>Cough<\/li>\n<li>Raised JVP<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Respiratory\n<ul>\n<li>PE\n<ul>\n<li>Haemoptysis<\/li>\n<li>Pleuritic<\/li>\n<li>COCP<\/li>\n<li>Smoking<\/li>\n<li>Long haul travel<\/li>\n<li>Recent surgery<\/li>\n<li>Malignancy<\/li>\n<\/ul>\n<\/li>\n<li>Pneumonia\n<ul>\n<li>Fever<\/li>\n<li>Cough<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>GI\n<ul>\n<li>Dyspepsia\n<ul>\n<li>Heartburn, reflux, nausea<\/li>\n<li>Relation to food<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Other\n<ul>\n<li>Musculoskeletal\n<ul>\n<li>Worse on palpation<\/li>\n<li>Worse with certain movements<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4><strong>Data gathering<\/strong><\/h4>\n<ul>\n<li>Red flags\n<ul>\n<li>See above<\/li>\n<\/ul>\n<\/li>\n<li>Examine\n<ul>\n<li>BP, (both arms) pulse (both arms)<\/li>\n<li>Temperature, Sats<\/li>\n<li>CVS, Resp<\/li>\n<li>Calves, Chest wall tenderness<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4><strong>Clinical management<\/strong><\/h4>\n<ul>\n<li>Treat as per cause<\/li>\n<li>If not urgent, consider\n<ul>\n<li>Investigations\n<ul>\n<li>Bloods &#8211; FBC, U+E, LFTs, TFTs, CRP, HbA1c, lipids<\/li>\n<li>ECG<\/li>\n<li>CXR<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Treatment\n<ul>\n<li>Assess likelihood of CAD (see below)\n<ul>\n<li>If &lt;10% likelihood of coronary artery disease\n<ul>\n<li>Consider non cardiac causes<\/li>\n<\/ul>\n<\/li>\n<li>If &gt;10% likelihood of coronary artery disease\n<ul>\n<li>Refer rapid access chest pain clinic (if new angina) + aspirin 75mg OD<\/li>\n<li>Refer cardiology clinic (if known IHD)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p><a href=\"https:\/\/papergp.com\/wp-content\/uploads\/2018\/02\/Chest-pain-CAD-risk-table.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-2108 size-thumbnail\" src=\"https:\/\/papergp.com\/wp-content\/uploads\/2018\/02\/Chest-pain-CAD-risk-table-150x150.png\" alt=\"\" width=\"150\" height=\"150\" \/>\u00a0Table to assess likelihood of CAD<\/a><\/p>\n<div class=\"content-box-blue\">\n<h4><strong>Source<\/strong><\/h4>\n<p><a href=\"https:\/\/gps.camdenccg.nhs.uk\/pathways\/chest-pain\">Camden CCG Chest Pain Pathway<\/a><\/p>\n<p><a href=\"https:\/\/patient.info\/doctor\/chest-pain-pro\">Patient.info Chest Pain Professional Reference<\/a><\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Differential diagnosis Cardiovascular Stable angina Typical for patient Constricting discomfort on exertion Resolves at rest\/GTN within 5 minutes ACS Pain at rest Increasing in frequency Nausea, sweats, lightheadedness Radiation to left arm\/jaw CV risk factors Duration &gt; 15 minutes Pericarditis Worse on inspiration Relieved by sitting forward Fever Pericardial rub Acute thoracic dissection Radiates to &hellip; <a href=\"https:\/\/papergp.com\/index.php\/cardiovascular\/chest-pain\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Chest pain<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":284,"menu_order":46,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-76","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/76","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=76"}],"version-history":[{"count":15,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/76\/revisions"}],"predecessor-version":[{"id":2109,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/76\/revisions\/2109"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/284"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=76"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}