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YEAR 3 Manchester Medicine > 1 - Chest pain > Flashcards

1 - Chest pain Flashcards

1
Q

What conditions are included in acute cornary syndrome?

A

Unstable angina, Non-STEMI, STEMI

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2
Q

Sudden onset of chest pain indicates…

A

Pulmonary embolism

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3
Q

Feeling of “severe ripping” radiating between the scapulars indicates…

A

Aortic dissection

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4
Q

Where does chest pain relating to ACS refer to?

A

Left arm, neck and jaw

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5
Q

What is angina (pectoralis)?

A

Discomfort of the chest and adjacent areas caused by myocardial ischaemia.

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6
Q

What is typical angina?

A

All 3 of: - discomfort in chest or neck, shoulder, jaw , arm - precipitated by physical exertion - relieved by GTN after 5 minutes

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7
Q

What is atypical angina?

A

2 of: - discomfort in chest or neck, shoulder, jaw , arm - precipitated by physical exertion - relieved by GTN after 5 minutes

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8
Q

Risk factors for coronary artery disease (same for peripheral artery disease)?

A
  • Age - Gender - Diabetes - hyperlipidemia - smoking - hypertension
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9
Q

Describe an aortic stenosis murmur

A
  • Ejection systolic - crescendo-decrescendo - left sternal edge, 2nd intercostal - refers to carotid
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10
Q

Describe a mitral regurgitation murmur

A
  • Pan systolic - constant through s1 to s2 - radiates to axilla
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11
Q

Describe a mitral stenosis murur

A
  • mid diastolic - though to s2 - apex with patient in left lateral position
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12
Q

Describe an aortic regurgitation

A
  • Early diastolic - diminuendo from S2 - left sternal edge 4th intercostal
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13
Q

MI affecting of papillary muscle leads too…

A

mitral regurgitation –> atrial dilation –> pulmonary hypertension –> pulmonary oedema –> crackle upon auscultation Atrial dilation can also lead to atrial fibrillation

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14
Q

What are the consequences of myocardial infarction?

A

Decreased contractility - Hypotension –> worsening ischaemia - blood stasis –> embolism Electrical instability - Arrythmias Necrosis - mitral/ tricuspid regurgitation - cardiac tamponade (heamoperricardium) - ventricular septal defect

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15
Q

What is the management of suspected ACS?

A
  • 300mg of aspirin - 12 lead ECG - Blood test: Troponins
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16
Q

How to diagnosing myocardial infarction.

A
  • raised troponin - + 1 more of: - symptoms of ischaemia - thrombus in angiogram - echo of infarct - pathological Q wave - ST changes
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17
Q

What scoring system is used for Ischaemic risk?

A

GRACE

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18
Q

What scoring system is used for bleeding risk?

A

CRUSADE

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19
Q

What does RILE stand for in relation to heart murmurs

A
  • Right - Inspiration - Left - Expiration
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20
Q

MI can lead to papillary muscle dysfunction causing the pathology of which murmur?

A
  • mitral regurgitation This leads to left atrial dilation (atrial fibrillation) and therefore pulmonary hypertension and therefore pulmonary oedema.
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21
Q

What is the most common pathology of a ejection systolic murmur?

A

Calcification of the aortic valve leading to aortic stenosis

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22
Q

ROMANCE

A

R - eassurance O - xygen M - orphine A - sprin N - nitrates C - lopidogrel (tricargelor) E - CG

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23
Q

MONC

A

M - orphine O - xygen N - itrates C - opidogrel

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24
Q

Treatment for STEMI/NSTEMI

A

PCI from 12 hours of onset and within 120 mins of admission, otherwise fibrinolysis.

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25
Q

Which is most common NSTEMI or STEMI?

A

NSTEMI

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26
Q

What indicates a STEMI on ECG?

A
  • ST elevation - peaked T waves followed by inverted T waves - new Q waves
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27
Q

Indication to call ambulance after using GTN:

A
  • try 2 twice - wait 5 mins - after 15 mins call ambulance
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28
Q

What other causes of MI are there apart from artery occlusion?

A
  • Aortic stenosis - Hypertrophic Cardiomyopathy (HOCM) - Tachyarrythmias - Cocaine use - Anaemia -Thyrotoxicosis
29
Q

What is the long term management of ACS?

A
  • aspirin for lyfe - DAPT for 12 months - statins - < 40% LVEF then add ACEi and B-blocker
30
Q

Patient has chest pain with no ST elevation on ECG however has a marked increase in troponin. What is the diagnosis?

A

NSTEMI

31
Q

ΔΔ PE

A
  • sudden onset pleuritic pain - associations: fever, SoB and haemoptysis - may notice unilateral swollen, hot, tender leg
32
Q

What is pleuritic pain?

A

Pain made worse by inspiration

33
Q

What diagnosis have pleuritic pain?

A
  • PE - pneumonia - tension pneumothorax - pericarditis
34
Q

ΔΔ GORD

A
  • burning sensation - worse when lying down, after eating, leaning forwards - sour taste in mouth - relieved by swallowing and water.
35
Q

ΔΔ pericarditis

A
  • relieved by leaning forward - worse when lying down
36
Q

What is a thrill?

A

A palpable murmur

37
Q

What risk factors included for clotting/ PE?

A
  • pregnancy - stasis -previous clotting event - smoking - surgery - malignancy - Varicous veins - DVT
38
Q

1st degree heart block

A

PR interval > 0.22

39
Q

Mobitz type 1

A
  • 2nd degree heart block - progressively longer PR interval
40
Q

Mobitz type 2

A
  • 2nd degree heart block - intermittent conduction of P waves
41
Q

3rd degree heart block

A
  • no condition of P waves
42
Q

Right bundle branch blocks

A

MaRRoW QRS pattern: - M in V1 - W in V6

43
Q

Left bundle branch block

A

WiLLiam QRS pattern: - W = V1 - M = V6

44
Q

Reporting a ECG

A
  • Rythmn - Conduction interval - Cardiac axis - QRS complex - ST and T waves
45
Q

Normal PR interval

A

0.12 - 0.22s

46
Q

Normal QRS

A

< 0.12s

47
Q

normal QT interval

A

around 0.4s

48
Q

Inferior ECG leads

A
  • III - aVF Right coronary artery
49
Q

Lateral ECG leads

A
  • I - II - aVL Left circumflex
50
Q

Anteriorlateral ECG leads

A
  • V4-6 - I -aVL left circumflex
51
Q

Anetior septal

A
  • V1-4 LAD
52
Q

Posterior

A
  • Tall T waves in V1-2 Right coronary and left circumflex
53
Q

How do T waves change from the time the MI occurs

A
  • early T waves are peaked - T waves become inverted
54
Q

Where is Q wave most prominent?

A

V6 - left ventricle depolarises first

55
Q

Characteristics of QRS in V1

A
  • no Q wave - R wave should be prominent
56
Q

Transitional point of an ECG

A

Deviation of the Q and R waves should be equal from the isoelectric point. Should be in V3-4. Indicates cardiac axis deviate

57
Q

ECG features of AF?

A
  • no P waves - irregular QRS activation - normal chape QRS
58
Q

ECG features of ventricular fibrillation?

A
  • no discernible QRS pattern
59
Q

ECG features of ventricular tachycardia?

A
  • no P waves - QRS are frequent and broad - no T waves
60
Q

ECG features of supra ventricular tachycardia?

A
  • many P waves - NOT sinus rhythm
61
Q

How can carotid massage stop supraventricular tachycardias?

A

Stimulates vaso-vagal responce to slow the heart rate

62
Q

In normal ECGs where can T waves be inverted?

A
  • aVR - V1
63
Q

Which mumur is related to a narrow pulse pressure which is slow rising?

A

Aortic stenosis

64
Q

Which mumur is related to a wide puse pressure and a collapsing pulse?

A

Aortic reurgitation

65
Q

Apart from GTN, what is 1st line management for angina?

A

ß-blocker or CCB

66
Q

What is the second line for management of angina?

A

ß-blocker and a CCB

67
Q

When a patient is suffering from angina with heart failure what is the recommended 1st line therapy?

A

Atenolol

68
Q
A

YEAR 3 Manchester Medicine (34 decks)

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