10. Chest Pain and IHD

Question 1

Name 3 pulmonary causes of chest pain

Answer 1

Pneumonia
Pulmonary embolism
Pneumothorax

Question 2

Name 3 non modifiable risk increasing factors for coronary atheroma

Answer 2

Age
Male
Family history

Question 3

Name 4 important modifiable risk factors for atheroma

Answer 3

Hyperlipidaemia
Smoking
Hypertension
Diabetes mellitus

Question 4

What does an atheromatous plaque consist of?

Answer 4

Necrotic centre and a fibrous cap

Question 5

What is the treatment for acute episodes of stable angina?

Answer 5

Sublingual GTN spray

Question 6

What is the difference in the atheromatous plaque in unstable angina?

Answer 6

Thinner fibrous cap so a thrombus formation is more likely to randomly occur

Question 7

What is the difference in terms of the infarct between a STEMI and an NSTEMI?

Answer 7

In a STEMI the infarct is the full thickness of the myocardium

Question 8

What can an ECG for unstable angina look like?

Answer 8

ST depression
T wave inversion
Normal

Question 9

How can you differentiate between an NSTEMI and unstable angina if e ECG looks normal?

Answer 9

The presence of biochemical markers would indicate an NSTEMI in this case

Question 10

How much myocardial necrosis is there in unstable angina?

Answer 10

None

Question 11

How much myocardial necrosis is there in an NSTEMI?

Answer 11

Some

Question 12

How much myocardial necrosis is there in a STEMI?

Answer 12

Large infarct

Question 13

A patient has high levels of troponin I in there blood, how do you differentiate between a STEMI and an NSTEMI?

Answer 13

An ECG, a STEMI will have ST elevation, an NSTEMI will not

Question 14

What feature of a STEMI ECG will become more apparent as time goes by?

Answer 14

Pathological Q wave

Question 15

Hours and days after the MI, what will happen to the ST elevation?

Answer 15

Becomes less elevated, T wave then inverts then returns to normal weeks later

Question 16

At what time does troponin peak?

Answer 16

18-36 hours after MI

Question 17

What time does troponin begin to rise?

Answer 17

3-4 hours after onset

Question 18

What is CK-MB?

Answer 18

The cardiac isoenzyme of creatine kinase

Question 19

When does creatine kinase peak and then return to normal?

Answer 19

Peak at 24 hours

Return to normal within 72 hours

Question 20

Why might you use creatine kinase over troponin when telling if a patient has had an MI?

Answer 20

If they have had a recent MI, troponin will remain for 14 days but CKMB will return to normal within 72 hours
It is therefore easier to tell if a second MI has occurred within this timeframe using CKMB

Question 21

What drugs can be used to prevent thrombus formation?

Answer 21

Anti platelet - aspirin

Anti coagulant - heparin

Question 22

What is an angiography?

Answer 22

Injecting an x Ray absorbing dye to view any vessel occlusions

Question 23

What is PCI (percutaneous coronary intervention)?

Answer 23

Angioplasty and stenting

Inflation of a balloon inside the occluded vessel expands a mesh that holds the vessel open

Question 24

What is a coronary bypass graft?

Answer 24

Using a vessel from elsewhere e.g. Internal mammary artery, radial artery or a saphenous vein put in reversed to graft onto the heart

Question 25

Name 3 cardiovascular causes of chest pain

Answer 25

Myocardial ischaemia - (tightening pain)
Pericarditis - (sharp pain)
Aortic dissection - (tearing pain)