Diff Dx - Referred Pain Patterns

Question 1

Cardiac Chest Pain Pattern

Answer 1

• Location: substernal/retrosternal (left or isolated midthoracic back pain in women) and aching in one or both upper arm
• referral: neck, jaw, shoulder or arms (L arm), may have toothache, occasionally the abdomen
• Description: viselike pressure, squeezing, heaviness, burning indigestion
• Intensity: mild to moderate
• Duration: usually less then 10 min, no greater than 30 min (average 3-5)
• Associated s/s: extreme fatigue, lethary or weakness in women, SOB (dyspnea), Nausea, Diaphoresis, anxiety, belching, heartburn, inhaling cold air (women), prolonged and repeated palpitations (women)
• Relieved: rest/nitroglycerin or antacids (women)
• Aggravating: exercise or physical exertion, cold weather or wind, heavy meals, emotional stress

Question 2

Myocardial Infarction Pain Pattern

Answer 2

• Location: substernal, anterior chest
• Referral: may radiate like angina, frequently down both arms
• Description: Burning, stabbing, viselike pressure, squeezing, heaviness
• Intensity: severe
• Duration: Usually at least 30 min, may last 1-2 hours
• Associated s/s: none with silent MI, dizziness, feeling faint, n/v, pallor, diaphoresis, apprehension, fatigue, sudden weakness, dyspnea
• Relieving: none, unrelieved by rest or NG taken every 5 min for 20 min
• aggravating: not necessarily anything, may occur at rest or may follow emotional stress or physical exertion

Question 3

Pericarditis Pain Pattern

Answer 3

• Location: substernal or over the sternum, sometimes to the left of midline toward the cardiac apex
• Referral: neck, upper back, upper trap, left supraclavicular, down L arm, costal margins
• description: more localized than MI pain
• Intensity: moderate to severe
• Duration: continuous
• Associated s/s: medically determined
• Relieving: sitting upright or leaning forward
• Aggravating: deep breathing, L lateral side bend, trunk rotation, supine position

Question 4

Aortic Aneurysm Pain Pattern

Answer 4

• Location: anterior chest (thoracic) or abdomen (abdominal), thoracic area of back
• Referral: pain may moe in the chest as dissection progresses, may extend into the beck, shoulders, interscapular area or lower back
• Decription: knifelike, tearing (thoracic), dull ache in lower back or midabdominal L flank
• Intensity: severe, excruciating
• Duration: hours
• Associated s/s: absent pulse, “abdominal heart beat”, lower BP in one arm, pulsating mass
• Relieving: none
• Aggravating: supine position accentuates symptoms