15 Chest Pain and Acute Coronary Syndrome Flashcards
What does SQITARS stand for?
Site Quality Intensity Time Aggravating Factors Relieving Factors Secondary Symptoms
What may cause chest pain (in general terms)?
1- MSK+Skin: e.g. Shingles, costochondritis, rib fracture 2-Lungs and Pleura: e.g. Pneumonia, pulmonary embolism 3-Heart 4- Aorta: e.g. Aortic Dissection 5- Oesophagus: e.g. Acid Reflux (burning), peptic ulcer disease
What characterises pleuritic chest pain?
- Well localised
- Worse on inspiration+coughing
- Stabbing/burning sensation
What would distinguish MSK/skin causes of chest pain from others?
Tenderness to palpate
What is ‘aortic dissection’?
Wall of aorta splits. Sharp, tearing pain- radiating to back
Is the cardiac tissue is affected, how might the pain be described?
-Dull/crushing -Poorly localised -radiating to shoulder/jaw/arm
What is pericarditis?
Inflammation of pericardium (often secondary- Viral Illness)
How would someone with pericarditis present?
- Retrosternal
- Sharp pain, localised- front of chest
- Pain eased on sitting up
- Pain aggravated w./ inspiration, cough, lying (as attached to diaphragm)
What is Ischaemic Heart Disease?
Pain secondary to pathology involving the heart (same risk factors as atherosclerosis)
If a patient has stable angina, how will they present?
-History- chest pain when exercising -No chest pain at rest -GTN spray (vasodilator) may relieve pain
Why does a patient with stable angina usually not present with pain at rest?
Heart tissue ischaemia only occurs when metabolic demands= greater than what can be delivered e.g. on exertion
What classifies as an ‘Acute Coronary Syndrome’?
1=Unstable Angina 2=Myocardial Infarction a-NSTEMI b-STEMI
What is Acute Coronary Syndrome?
Acute myocardial ischaemia- due to atherosclerotic coronary artery disease
Describe the process causing Acute Coronary Syndrome.
1- Plaque ruptures 2- Thrombus formation 3-Acute increased occlusion 4-Ischaemia then potential infarction
How would a patient with Unstable Angina present?
Similar to stable angina + -Pain at rest -Pain more intense -Pain last longer -Autonomic response e.g. sweating, nausea (can progress to MI)
How would a patient experiencing an MI present?
Similar to Unstable Angina
+
- More severe autonomic response
- Pulse rate increase
How do you differentiate between a STEMI and UA/NSTEMI on an ECG?
(st segment and t wave)
ST segment elevation=STEMI
ST segment depression=UA/NSTEMI
Hyperacute T-wave= STEMI
Flattened/inverted T-wave= UA/NSTEMI
What changes on a normal ECG are suggestive of ischaemia or infarct?
-ST segment elevation/depression -T waves widespread/inverted - Pathological Q-waves
How would you differentiate between Unstable Angina and NSTEMI?
Blood test: rise in troponin if infarcted
