A7- Chest Pain Flashcards
What are the causes of chest pain?
MI, Pericarditis, myocarditis, endocarditis, aortic dissection, MVP
Pneumonia, pleurisy, PE, tension pneumothorax
Trauma, fracture ribs, metastases
Gastritis, oesphagitis, PUD, oesphageal rupture, cholecystitis, pancreatitis
Muscular pain, arthritis, radiculopathy
What symptoms would indicate ACS
Pain in the chest and/or other areas (for example the arms, back or jaw) lasting longer than 15 minutes
Chest pain associated with nausea and vomiting , marked sweating, breathlessness or particularly a combination of these
Chest pain associated with haemodynamic instability
New onset chest pain, or abrupt deterioration in previously stable angina with recurrent chest pain occuring frequently and with little or no exertion and with episodes often lasting longer than 15 minutes.
What should you do next if you suspected ACS
Perform 12 lead ECG as soon as possible
What is immediate management of ACS
Pain relief - GTN initially
300mg aspirin loading dose
Monitor pulse, blood pressure, O2 sats and heart rhythm
Take blood for troponin measurement
Oxygen is not to be given routinely (unless Sp02 <94%)
Immediate assessment
- Haemodynamic status
- Signs of complication- pulmonar oedema, cardiogenic shock
- Signs of non- coronary causes of acute chest pain
What are ix to b considered for non coronary causes of acute chest pain
CXR- complication of ACS such as pulmonary oedema other diagnoses- pneumothorax/pneumonia
CT chest- rule out other diagnoses such as pulmonary embolism or aortic dissection - not to diagnose ACS
- 70 year old female presents with sudden onset of recurrent severe central chest pain over 12 hours
- PMH: treated for hypertension and hyperlipidaemia; Type II diabetic; no previous aspirin intake
- Non smoker
- No FH of CVS • Clinical examination: BP 120/80. Chest clear
- Hs-cTnT: 20ng/mL (N= 0-0.4)
- Creatinine 130umol/L; Hb 130g/L
- ECG performe
- Sinus tachycardia (140 beats per minute)
- Horizontal/down sloping ST depression leads V4-V6 +and AVL
- ST elevation lead AVR (the reciprocal lead)
- Axis approximately 0 degree (90 degree opposite to AVF, where you see equal positive and negative deflection)
- Diagnosis: NSTEMI
What is the GRACE score
The GRACE Score is a prospectively studied scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality. Like the TIMI Score, it was not designed to assess which patients’ anginal symptoms are due to ACS
This is this patient’s left coronary angiogram. What does it show and what is the treatment needed?
Needs emergency CABG’s!
ST changes of pericarditis
Wide spread concave ST elevation with PR depression
- 35 year old male presents with severe chest pain via 999 call and paramedics perform an ECG
- BP-160/100mmHg; P-60 regular
- Given IV pain relief
- Following this the PPCI pathway is activated and the patient arrives at the Heart Attack Centre
- BP-160/105mmHg; no murmurs
What does ECG show
•Global ST elevation in all leads apart from I and AVL is present
What is the definition of angina
Angina Patho
Factors reducing ischaemia. Such factors may render severe lesion (>70%) asymptomatic
- well developed collaeral supply
- Small mass of ischaemic myocardium: distally located lesions
- Old infarction in the territory of coronary supply
Diagnosis of angina
What are factors that make angina more likely
What makes angina less likely
Inital ix for Angina
What is diagnostic ix for angina
Pros and cons of CT coronary angiography
ETT advantages
ETT disadvantages
