Cardio Anatomy - Differential Diagnosis of Chest Pain

Question 1

Visceral afferents are pain fibres that travel to the spinal cord alongside?

Answer 1

Sympathetic nerves

Question 2

Reflex visceral afferents travel mainly in the? Less so in the?

Answer 2

Vagus nerve (CN X)
Glossopharyngeal nerve (CN IX)

Question 3

Is sympathetic innervation to the heart uni- or bilateral?

Answer 3

Bilateral

Question 4

Where do cardio-splanchnic nerves that supply sympathetic innervation to the heart and lungs come from?

Answer 4

T1-T5 ganglia + cervical ganglia

Question 5

What nerve fibres does the cardiac plexus contain?

Answer 5

Sympathetic
Parasympathetic
Visceral afferent

Question 6

Parasympathetic signals reach the heart via?

Answer 6

The vagus nerve, CN X

Question 7

Pain is stimulation of a?

Answer 7

sensory receptor

Question 8

Somatic pain is typically?

Answer 8

Sharp, stabbing and well localised in nature

Question 9

Visceral pain is typically?

Answer 9

dull, aching, nauseating and poorly localised

Question 10

Where does somatic (body wall structure) pain come from?

Answer 10

Muscular
Joint
Bony
Intervertebral disc
(fibrous) pericardial
Nerve

Question 11

Where does visceral pain come from?

Answer 11

Heart and great vessels
Trachea
Oesophagus
Abdominal viscera

Question 12

Where does cardiac pain usually radiate to?

Answer 12

Upper limbs
Back
Neck

Question 13

What is radiating pain?

Answer 13

The pain is felt both at the actual site of the pathology and also radiating (spreading away from there)

Question 14

What causes radiating pain?

Answer 14

Visceral afferents (pain fibres from orgins) plug into the spinal cord at the same time as somatic sensory fibres enter the spinal cord

Question 15

When skin mechanoreceptors are stimulates the AP is propagated centrally to the CNS and sensation reaches consciousness where?

Answer 15

at the cerebral cortex

Question 16

Where does the pain pathway cross?

Answer 16

In the spinal cord

Question 17

Body wall sensations are brought into consciousness by APs arriving in the?

Answer 17

Postcentral gyrus of the parietal lobe (somatosensory)

Question 18

APs originating from the pre central gyrus of the frontal lobe bring about contractions of?

Answer 18

Body wall skeletal muscle (somatic)

Question 19

In reference to radiating pain, if pain is originating in a somatic structure the radiation is along the affected?

Answer 19

Dermatome(s)

Question 20

If from the heart, the radiation is bilaterally to which dermatomes?

Answer 20

Cervical and upper thoracic dermatomes

Question 21

Visceral radiating pain is ____ in nature

Answer 21

aching, dull and poorly localised (visceral)

Question 22

Referred pain is?

Answer 22

the sensation of pain is “felt” ONLY at a site remote from the actual area of injury or disease

Question 23

What causes referred pain?

Answer 23

Due to afferent (sensory) fibres from soma and afferent (sensory) fibres from viscera (visceral afferents) entering the spinal cord at the same levels

Question 24

Which arteries are commonly used as grafts for coronary artery revascularisation?

Answer 24

Radial artery
Internal thoracic artery
Great saphenous vein

Question 25

AV node damage results in what type of heart block?

Answer 25

Complete heart block

Question 26

Bundle branch damage results in?

Answer 26

Bundle branch block