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Pulmonary Embolism

Sudden onset of unilateral chest pain
Worse on inspiration
Pain accompanied by breathlessness (dyspnoea) and coughing up blood (haemoptysis)
Sinus Tach Obstructive shock, hypotension


Central chest pain worse on inspiration
Relieved by sitting forward
Pericarditis friction rub

Stable angina- narrowing of coronary artery

Chest pain on exercise
Crushing, squeezing sensation, radiates to the jaw, neck and left arm

Unstable angina- partial occlusion of coronary artery

Chest pain at rest
Presented as cold and sweaty (Sympathetic NS)
ECG: T wave inversion

MI- myocardial necrosis

Pain radiates to neck, shoulders and arm
Requires intravenous opioids (diamorphine)
Unrelieved by GTN
Raised serum biomarkers

Aortic dissection

Severe tearing, ripping pain that radiates through the back between the shoulder blades


Severe reduction in cardiac contractility
Raised CVP, low CO


Mechanical obstruction to cardiac output - pulmonary embolus
Increased afterload


Cause: Haemorrage, burns, diarrhoea, excessive diureses
decreased circulating bloodd volume
decreased CO CVP

Distributive (septic)

Increased vascular capacitance
Decreased central venous pressure
Allergens, bacterial toxins

Septic shock

Type of distributive shock
Gram +ve: Staph Aureus exotoxin TSS
Gram -ve: LPS endotoxin SIRS

Toxic Shock syndrome

Macular rash, fever desquamation, hypotension

Secondary Hypertension

BP> 120/80 mmHg
Renal problems
Endocrine Dysfunction: Conns, Hyperthyroidism, Acromegaly, Phaeocromocytoma, Cushings syndrome
Coarctation of Aorta
Ionotropic: NSAID, hormones

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