10. Chest Pain And Acute Coronary Syndromes Flashcards
What kind of chest pain does cardiac ischaemia cause?
Dull
Centre chest (retrosternal)
Radiates (jaw, neck, shoulders)
Worse with exertion
What kind of pain does pericarditis cause?
Sharp, located to front of chest
Central (retrosternal)
Worse with positional moving (inspiration, cough, lying flat), eased with sitting up and leaning forwards
What type of pain is present in aortic dissection? Is it caused by atherosclerosis?
Sharp, right through to back
Not caused by atherosclerosis
What is pericarditis?
Inflammation of the pericardium, often secondary to a viral illness
What may be heard on auscultation in pericarditis?
Pericardial rub
What is seen in pericarditis on an ECG?
ST elevation in all leads
What is ischaemic chest pain?
Pain secondary to pathology involving the heart
What are acute coronary syndromes?
Acute myocardial ischaemia caused by atherosclerotic coronary artery disease. Are a spectrum of increasing occlusion from a common pathophysiologic mechanism
What is atherosclerosis?
Lipid-laden core with a fibrous external cap, which builds up over time. Fibrous outer can rupture with thrombus formation, breaking off and causing problems
Give some risk factors for atherosclerosis and therefore ischaemic heart disease
Smoking Hypertension Hypercholesterolaemia Diabetes Obesity Sedentary lifestyle Family history Age Male
What is stable angina?
Narrowing of artery by a stable atherosclerotic plaque. Heart tissue ischaemia only occurs when metabolic demands of cardiac muscle are greater than what can be delivered via coronary arteries
What are the triggering and relieving factors in stable angina?
Triggered - by exertion
Relieved - on rest (no chest pain at rest), GTN spray
Is stable angina an acute coronary syndrome?
No
Do you get cardiac enzyme leak in ischaemia and/or infarction?
Ischaemia - no cardiac enzyme leak
Infarction - cardiac enzymes lead from necrosis cardiac muscle cells
What blood test may you want to do in suspected acute coronary syndrome?
Troponin - indicateds cardiac myocyte death
So can be used to distinguish between unstable angina and NSTEMI
