Cardiovascular: Session 8

Question 1

What some causes of chest pain?

Answer 1

• Cardiac pathology
  
  • Ischaemic
  • Pericarditis
• Respiratory pathology
  
  • Pulmonary embolism
  • Pneumonia
• Musculoskeletal pathology
  
  • Rib fracture
  • Costochondritis
• Upper Gastrointestinal Reflux

Question 2

What some symptoms of pneumonia? (respiratory associated chest pain)

Answer 2

• Pain in the sides of the patient
• Temperature
• Cough
• Breathlessness

Question 3

What are some symptoms of pulmonary embolism?

Answer 3

• Breathlessness
• Chest pain is sharp
• Well localised
• Worse with inspiration
• Cough

Question 4

What are some symptoms of constochondritis?

Answer 4

• Sharp well localised pain
• Tender to palpate
• Worse with movement of chest walls
• Coughing with inspiration

Question 5

What are some symptoms of pericarditis?

Answer 5

• Retrosternal chest pain
• Sharp pain, localised to front of the chest
• Aggravated with inspiration, cough, lying flat
• Eased with sitting up and leaning forward
• Pericardial rub may be heard on auscultation

Question 6

What are some symptoms of ischaemic heart pain?

Answer 6

• Dull retrosternal chest pain
• Heaviness
• Central pain radiating to the jaw, neck and shoulder

Question 7

What are some symptoms of upper gastrointestinal related chest pain?

Answer 7

• Burning pain
• Can be felt centrally or going upwards
• Certain food or lying flat can make it worse

Question 8

What is pericarditis?

Answer 8

Inflammation of the pericardium often secondary to a viral illness.

Question 9

What are the modifiable risk factors of atherosclerosis?

Answer 9

• Smoking
• Hypertension
• Hypercholesterolaemia
• Diabetes
• Obesity
• Sedentary lifestyle

Question 10

What some non-modifiable risk factors of atherosclerosis?

Answer 10

• Advanced age
• Family history
• Male

Question 11

When does heart tissue ischaemia occur in stable angina?

Answer 11

Heart tissue ischaemia occurs only when metabolic demands of cardiac muscle are greater than what can be delivered via coronary arteries.

Question 12

What conditions are included in acute coronary syndrome?

Answer 12

• Unstable angina
• Myocardial infarction
• Non-ST elevation myocardial infarction (NSTEMI)
• ST elevation myocardial infarction (STEMI)

Question 13

What are the sequence of events that lead to an acute coronary syndrome?

Answer 13

• Atherosclerotic plaque ruptures
• Platelet aggregation and formation of thrombus
• Formation of completely occlusive thrombus from partially occlusive thrombus

Question 14

What is the difference between heart tissue death and heart tissue ischaemia?

Answer 14

Cardiac enzymes leak from necroses cardiac muscle cells after death. (Troponin I)

Question 15

What is the history of a patient with stable angina?

Answer 15

• Dull, retrosternal chest pain triggered by exertion
• Chest pain is relieved by rest. No chest pain at rest
• GTN spray can relieve the pain

Question 16

What the typical history of a patient with unstable angina?

Answer 16

• Dull retrosternal chest pain occurs at rest

- The pain may be more intense and last longer than in stable angina

Question 17

What are the diagnostic tests in suspected acute coronary syndrome?

Answer 17

ECG

• Changes suggestive of current ischaemia or infarct
• Look at ST segments, T waves +/- pathological Q waves

Blood tests
-Troponin - presence indicates cardiac myocyte death

Other investigations

• To exclude other potential diagnosiss
• To identify potential complications

Question 18

What are the ECG changes to STEMI?

Answer 18

Patterns of infarct

• ST segment elevation
• Hyperacute T waves

The localisation of the changes helps to determine anatomical site

Question 19

What are the ECG changes in unstable angina and NSTEMI?

Answer 19

• ST segment depression

- T wave flattening or inversion

Question 20

How would you differentiate between the NSTEMI and unstable angina?

Answer 20

Test the troponin I which will be present in an NSTEMI.