Cardiac Symptoms Flashcards
what is the first step in cardiac history taking?
describe the following:
Location, quality, severity, timing, setting in which it occurs, remitting or exacerbating factors and associated symptoms to the pain
identify the symptomatic description with the disease
- Tearing” or “ripping”; may travel from anterior chest to mid-back
- Crushing, sharp, pleuritic; relieved by sitting forward
- Intense substernal and epigastrIc hematemesis
- Very sharp, pleuritic
- Squeezing; may radiate to arm(s), neck, back
- Aortic dissection
- Acute pericarditis
- Rupture of esophagus
- Acute Pneumothorax
- Acute MI
what are the 2 types of angina pectoris?
- Stable
- Prinzmetals
into what categories can we classify acute coronary syndrome?
- STEMI
- Non STEMI
- Unstable angina
what are the ischemic heart diseases?
Angina pectoris and Acute coronary syndrome
what are the Non ischemic heart diseases?
- Pericarditis
- Aortic dissection
- Arrhythmias
what are the Non Cardiac causes for chest pain?
- Respiratory: Pleurisy, Pneumothorax, Pulmonary embolism
- Gastrointenstinal: GERD, Peptic ulcer, Gall stones
- chest wall: costochondritis ,Herpes zoster
- psychogenic chest pain: Anxiety, panic attack, Hypochondria.
what is Acute Pericarditis?
when will the patient feel relief?
what exacerbates the symptoms?
what is the Classic sign?
what 2 procedures can be ordered to confirm?
what will you detect in the procedures?
- inflammation of adjacent parietal pleural leadign to Sub-sternal pain with radiation to the trapezius ridge
- shallow breathing and by sitting up and leaning forward.
- lying down and inspiration
- friction rib heard over lower left sternal border
- echocardiogram (diffuse pericardial effusion) and ECG (ST elevation and PR depression)
what is this showing?
ST elevation
while doing an echocardiogram on suspected acute pericarditis, what leads will show ST elevation?
all except aVR and V1
what is aortic dissection?
what 2 conditions are associated with it?
what clinical finding can be detected?
how do you confirm aortic dissection?
- Sudden, severe “tearing” pain, radiating to the abdomen, neck, or back, depending on where the dissection is going
- Marfans and hypertension
- weak asymmetric pulses, wide mediastinum for chest x-ray, intimal flip is visualized in MRI and CT
- aortic angiogram
what are arrhytmias?
the heart will beat how?
what decides if it is harmful or harmless?
- The abnormal rhythms or an irregular heartbeat.
- Heart may beat too quickly, too slowly or erratically.
- whether the atria or ventricle is affected and how well the heart is able to continue pumping blood.
what are the 5 Most Common Arrhythmias?
- Tachycardia
- Bradycardia
- Atrial fibrillation (A-fib)
- Ventricular Fibrillation
- Palpitations
what is Angina Pectoris: Stable angina?
what makes it worse?
what makes the pain go away?
why does it happen?
do you see necrosis?
- Squeezing, crushing, strangling, constricting pain in center of chest, radiate to left shoulder, arm, jaw
- exercise
- rest or after sublingual nitroglycerine
- Subendocardial ischemia due to decreased coronary artery blood flow
- no
***Why stress precipitates the pain?????
Sub endocardium gets the least amount of oxygen from coronary arteries. Coronary arteries fill in diastole and increasing HR decreases time for filling of coronary arteries
how do you diagnose stable angina?
how do you confirm the diagnosis?
- Stress test
- look for ST segment depression that reverses after disappearance of ischemia
- No elevation in cardiac biomarkers
- Confirmed by angiography
what is the treatment for stable angina?
what can be used for prevention of stable angina?
- Nitroglycerin S/L is the DOC
- long acting nitrates
- Betablockers,
- Ranolazine (decreases late sodium current and intracellular calcium overload )
- Aspirin
what is another name for Prinzmetal’s angina?
what causes it?
when is it seen?
what may be used to relieve the pain?
what makes the pain come back?
- variant angina or non-classical or vasospastic angina
- coronary vasospasm NOT OBSTRUCTION!!
- angina at rest, usually in the morning (it may awaken ppl from sleep)
- nitrates
- smoking or cocaine use
how do you diagnose variant angina?
what is the treatment for variant angina?
what drug is contraindicated?
- ECG will show transient ST elevation
- No elevation in cardiac biomarkers
- Angiography demonstrates not significant coronary obstruction but “coronary spasm”
- nitrates and CCB
- beta blockers
what is refered to Acute coronary syndromes (ACSs)?
acute coronary syndromes can be Classified based on ECG as what?
which is the worst?
- comprise the spectrum from unstable angina to severe acute MI
- “ST elevated ” or “Non ST elevated”
- ST elevated: ST Elevated MI (STEMI) is most severe form, needs immediate reperfusion.
in acute coronary syndromes, if there is no ST elevation, what 2 things could it be?
What is the main difference between NSTEMI and unstable angina?
In which (NSTEMI or unstable angina) will you detect raised cardiac enzymes?
Unstable angina or NSTEMI
that in NSTEMI the severity of ischemia is sufficient to cause cardiac enzyme elevation.
raised in NSTEMI and not in unstable angina
What happens in STEMI?
what may lead to STEMI?
what is used to treat it?
- there is a transmural infarction of the myocardium - which just means that the entire thickness of the myocardium has undergone necrosis - resulting in ST elevation.
- Usually due to a complete block of a coronary artery (occlusive thrombus).
- thrombolytics like Streptokinase to lyse the thrombus or tPA
what causes unstable angina and NSTEMI?
what can be absent and confirm it?
- partial dynamic block to coronary arteries (non-occlusive thrombus).
- no ST elevation or Q waves on ECG, as transmural infarction is not seen.
answer the table
