Acute Chest pain Flashcards
5 main causes of chest pain
- ACS
- PE
- Aortic dissection
- Pneumonia
- Pneumothorax
PE symptoms
- acute onset 2. Sharp chest pain 3. Breathlessness 4. Calf pain 5. Tachycardia
Well’s criteria
- Haemoptysis 2. Malignancy 3. Previous DVT/PE 4. Heart rate > 100 beats per minute 5. Surgery 6. Suspected DVT
Initial Ix for chest pain
- appearance
- vital signs
- ECG
- CXR
- troponin
- ABG
- D - dimer
ECG for PE (textbook example)_
SIQ3T3
- S waves in lead I
- Q waves in lead III
- Inverted T waves in lead III
Treatment for PE
- Shocked - thrombolysis 2. Anticoagulants to halt clot progression and allows fibronlysis
Aortic dissection
a serious condition where there is a tear in the intima of the aorta. 2. blood flow in the inner and outer layers of the media
Types of aortic dissection
- Ascending aorta 2. Arch of the aorta and descending 3. Descending aorta
What patients may have MI but no chest pain?
- elderly
- diabetic
*due to autonomic dysfunction
Typical SOCRATES in Hx of patient with MI
Changes on ECG that classify as STEMI MI
Pericarditis changes on ecg
Smiley, upsloping ST segments
Changes on ECG associated with cocaine use
- high take-off
- vasospasm is common
ECG changes in a cardiac infarction
What ‘J point’ is used for?
- Look at J point to assess how much higher or lower from a base line
- the J point (to assess for ST elevation)
Regions ECG
What is it suggestive of:
Elevated troponin + chest pain + suggestive ECG changes
MI
Treatment of acute ST elevation MI
- Oxygen -> only when needed (depends on sats)
- Nitrates -> to vasodilate the arteries
- Symptomatic treatment with opiates and antiemetics -> if needed
- Anti-platelet etc - to prevent clots from spreading
Is troponin elevated in:
A. unstable angina
B. Non-STEMI
A. Unstable angina - troponin is normal
B. Non-STEMI - troponin is elevated
Changes on ECG suggestive of transmural ischaemia
ST elevation
Changes on ECG suggestive of subendocardial ischaemia
- ST depression
- T inversion
What’s the tool to assess the likelihood of a chest pain being cardiac?
+ meaning
- 0-3 = low risk (<2%)
- 4 - 6 = medium risk (12 - 17%)
- 7-10 = high risk (50 - 65%)
Treatment for unstable angina/Non-STEMI
Typical SOCRATES (Hx) in PE
Signs on examination of a pt with PE
Investigations in PE
Treatment of PE
- if shocked -> thrombolyse
• if not shocked -> anti-coagulate (to stop clot progression and allow fibrinolysis)
SOCRATES (on Hx) of a patient with aortic dissection
Signs and symptoms in aortic dissection
Investigations in aortic dissection
- CT - gold standard
- CXR
- ECHO
- TOE (transoseophageal ECHO)
Treatment for aortic dissection
Surgery
Characteristic of chest pain in pneumothorax
- chest pain
- worse on inspiration (usually)
- sharp
- can be mild or severe
Differences of tension vs non-tension pneumothorax on x-ray
tension - mediastinum is pushed to the sie
Ix for pneumothorax
- Vital signs - may show signs of shock
- Auscultation - may hear reduced air entry on that side (may not)
- Hyper-resonant affected side
- CXR
- US -> to confirm if any doubt
