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Cardiology > CASE STUDY CHEST PAIN > Flashcards

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
Q

What is unstable angina ?

A

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
Q

What is the difference between angina and infarction?

A

angina is ischemia
Infarction is cell death !

24
Q

What are reciprocal changes?

A
25
Q

LBBB and acute onset chest pain, should you be concerned?

A

suspect MI unless proven otherwise if its sudden and unset

26
Q

Why would you give morphine for tachycardia

A

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
Q

When do you get 02 for an MI?

A

sats less than 90

28
Q

If a patient is on regular aspirin would you give 300mg of aspirin in a STEMI ?

A

YES

29
Q

What will treat a STEMI in less than 12 hours ?

A

STENT - reperfuse the artery

OR

STREPTIKANASE

30
Q

What will treat a STEMI in more than 12 hours ?

A

talk to the cardiologists

31
Q

what type of troponins are there

A

T and i

32
Q

What does troponin show

A

myocyte necrosis

33
Q

When do troponins rise?

A

2-3 hours onset of pain

34
Q

What bloods would you do ?

A

Potassium
Magnesium
Troponins
D-dimer

Finger blood sugar

35
Q

If you have a choice of primary PCI or fibrinolysis would you choose ?

A

PCI

36
Q

How many minutes can you perform an PCI with a presenting at the hospital

A

120 minutes

37
Q

When must patients with cardiac-sounding chest pain be seen on the same day and presented to the GP? eg transferred to the hospital

A

Cardiac-sounding chest pain within 72 hours

37
Q

What is known as broken heart syndrome?

Seen after catastrophic events

A

Takisubu

Not any treatment - have to watch and wait

Looks like a figure of 8 on a echocardiogram

38
Q

What else can rasie troponins

A

myocarditis
HF
PE
sepsis/ infection

39
Q

What else can cause ST elevation ?

A
  • Myocarditis
  • Pericarditis
    -Stress cardiomyopathy (Takotsubo),
  • Benign early repolarization, Acute vasospasm, spontaneous coronary artery dissection, left bundle branch block, various channelopathies, and electrolyte abnormalities
40
Q

What is the gold standard stent to be used for PCI?

A

Drug-eluting stent

41
Q

Complications of MI

A

Heart failure
Arthymias
Death
Acute (usually mitral) regurgitation
Aneurysm of the left ventricle if it died
Thrombus originating from the heart

42
Q

Can people having symptoms of an MI drive themselves to the hospital?

A

Absolutely not

43
Q

Pharmacological management

A

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
Q

Advice on sexual activity following MI

A

If you can climb a flight of stairs then youre ok

45
Q

How long can you drive after a MI but did not have a stent or had one and did not work

A

1 month

46
Q

How long can you drive after a stent

A

1 week

47
Q
A

Cardiology (18 decks)

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