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CASE STUDY CHEST PAIN Flashcards

1
Q

How long would you get chest pain before thinking no longer angina?

A

15 minutes

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2
Q

What are the associated symtoms of an MI ?

A
  • Nausea
  • Impending doom
  • Sweating
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3
Q

What relieves angina

A

GTN and rest

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4
Q

Why do you need to know the onset for an MI ?

A

Will determine the treatment <> 12 hours

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5
Q

what is PND?

What does it gradually progress to?

A

Paroxysmal nocturnal dysponea

Orthopnea

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6
Q

Symptoms of Paroxysmal nocturnal dysponea ?

A

Paroxysmal nocturnal dyspnea (PND) is a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep and is usually relieved in the upright position.

As this condition gets worse the time will slowly become less and less.

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7
Q

What is syncope

A

loss of consciousness

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8
Q

CARDIAC RED FLAGS

A

Breathlessness
Leg or ankle swelling – oedema
Palpitations
Fatigue
Lightheaded – syncope or presyncope

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9
Q

What PMH would you want to know in cardiac pain ?

A
  • Smoking
  • Cholesteral
  • Diabietes
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10
Q

What illicit drug would you consider with a young person with ST elevation?

A

cocaine

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11
Q

Who dont present with mi symptoms the same way

A
  • Young people (especially cocaine users)
  • elderly people
  • Farmers
  • Diabetics
  • Women
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12
Q

What type of medication is asprin ?

A

Antiplatelet

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13
Q

What type of medication is amlopdipine?

A

CCB

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14
Q

pansystolic mummur

A

Mitral regurgitaion

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15
Q

What can be used to assess mortality in acute MI ?

A

Killips class
Grace score (more commonly used in NSTEMI)
In NCIC they use HEART.

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16
Q

How do you figure out rate ?

A

R- R / 300

or the sheet (10 seconds) x 6

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17
Q

When is an qrs completely considered broad

A

> 3 small squares

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18
Q

What is the isometric line

A

The line the ECG returns to

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18
Q

What is this ?

A

Acute inferior STEMI with complete heart block

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18
Q

Pathological Q waves

A

previous MI

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18
Q

What are Hyperacute T waves?

A

Happen before the ST elevation - the first ECG change when a artery completely occludes.

19
Q

What type of MI often also presents with a heart block ?

A

Inferior MI

20
Q

What is stable angina

A

Stable angina - Stable (or ‘exertional’) angina is defined as:
* Typical cardiac pain
* Brought on by exertion and relieved by rest
* Lasting less than 20 minutes

21
Q

What is ACS

A
  • Non-stable angina
  • NSTEMI
  • STEMI

STABLE ANGINA IS NOT INCLUDED IN THIS

22
What is unstable angina ?
Unstable angina is an acute coronary syndrome that is defined by the absence of biochemical evidence of myocardial damage. It is characterised by specific clinical findings of: 6 Crescendo angina !!! * prolonged (>20 minutes) angina at rest * new onset of severe angina * angina that is increasing in frequency, longer in duration, or lower in threshold * angina that occurs after a recent episode of myocardial infarction
23
What is the difference between angina and infarction?
angina is ischemia Infarction is cell death !
24
What are reciprocal changes?
25
LBBB and acute onset chest pain, should you be concerned?
suspect MI unless proven otherwise if its sudden and unset
26
Why would you give morphine for tachycardia
The coronary arteries fill during diastole, and if she becomes tachycardia, there will be less time for the coronary arteries to refill and get an oxygen supply.
27
When do you get 02 for an MI?
sats less than 90
28
If a patient is on regular aspirin would you give 300mg of aspirin in a STEMI ?
YES
29
What will treat a STEMI in less than 12 hours ?
STENT - reperfuse the artery OR STREPTIKANASE
30
What will treat a STEMI in more than 12 hours ?
talk to the cardiologists
31
what type of troponins are there
T and i
32
What does troponin show
myocyte necrosis
33
When do troponins rise?
2-3 hours onset of pain
34
What bloods would you do ?
Potassium Magnesium Troponins D-dimer Finger blood sugar
35
If you have a choice of primary PCI or fibrinolysis would you choose ?
PCI
36
How many minutes can you perform an PCI with a presenting at the hospital
120 minutes
37
When must patients with cardiac-sounding chest pain be seen on the same day and presented to the GP? eg transferred to the hospital
Cardiac-sounding chest pain within 72 hours
37
What is known as broken heart syndrome? Seen after catastrophic events
Takisubu Not any treatment - have to watch and wait Looks like a figure of 8 on a echocardiogram
38
What else can rasie troponins
myocarditis HF PE sepsis/ infection
39
What else can cause ST elevation ?
- Myocarditis - Pericarditis -Stress cardiomyopathy (Takotsubo), - Benign early repolarization, Acute vasospasm, spontaneous coronary artery dissection, left bundle branch block, various channelopathies, and electrolyte abnormalities
40
What is the gold standard stent to be used for PCI?
Drug-eluting stent
41
Complications of MI
Heart failure Arthymias Death Acute (usually mitral) regurgitation Aneurysm of the left ventricle if it died Thrombus originating from the heart
42
Can people having symptoms of an MI drive themselves to the hospital?
Absolutely not
43
Pharmacological management
Asprin indefinitely Dual anti-platelet for 12 months Beta-blocker ( prevents negative remodelling) for one year. ACE inhibitor (helps prevent negative remodelling) STATINS B- blocker and ACE start on a low dose and gradually increase as required.
44
Advice on sexual activity following MI
If you can climb a flight of stairs then youre ok
45
How long can you drive after a MI but did not have a stent or had one and did not work
1 month
46
How long can you drive after a stent
1 week
47

Cardiology (18 decks)

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