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Cardio > Central Chest Pain > Flashcards

Central Chest Pain Flashcards

1
Q

If chest pain is of a constricting nature, what are the likely differentials?

A

Angina
Oesophageal spasm
Anxiety

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2
Q

If chest pain radiates to the shoulder, arms, or neck/jaw what is a likely differential?

A

Cardiac ischaemia

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3
Q

What is the characteristic pain presentation of aortic dissection?

A

Instantaneous, tearing and inter scapular

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4
Q

How does pericarditis pain improve?

A

Leaning forward

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5
Q

What conditions can cause angina?

A

Coronary artery disease
Cardiomyopathy
Aortic stenosis

Can be exacerbated by anaemia

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6
Q

What does chest pain with tenderness suggest?

A

Self-limiting Tietzes syndrome (benign inflammation of costal cartilages)

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7
Q

If there is pain on respiration, exacerbated by gentle pressure on the sternum, what does this indicate?

A

Fractured rib

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8
Q

If BP is unequal in both arms, what condition does this point towards?

A

Aortic dissection

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9
Q

What pathologies can cause palpitations?

A 
Ectopics
Sinus tachycardia
AF
SVT and VT
Thyrotoxicosis
Anxiety
Phaeochromocytoma
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10
Q

What are the cardiovascular causes of chest pain?

A

Angina
MI
Pericarditis
Dissecting AA

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11
Q

What are the pulmonary causes of chest pain?

A

Tracheobronchitis (on either side of the sternum there is burning pain, exacerbated by coughing, relieved by lying)

Pleurisy
Pneumonia
Both of the above present as sharp and knife-like

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12
Q

What are the GI causes of chest pain?

A

GORD

Oesophageal spasm

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13
Q

What is the pre-hospital management of an acute MI?

A 
MONA
Morphine
Oxygen (if <94% sats)
GTN
300mg aspirin
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14
Q

What is the in-hospital management of a STEMI?

A

Aspirin, antiplatelet (ticagrelor/prasugrel) and LMWH (enoxaparin) prior to PCI

PCI if it can be delivered <120 hours and <12 hours before the onset of chest pain

OTHERWISE

Fibrinolysis and check ECG after 90 minutes
If no resolution, angiography and follow on PCI

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15
Q

What is the in-hospital management of a NSTEMI?

A 
Give clopidogrel
Give antithrombin (unless if at a bleeding risk)
Use the GRACE score to predict mortality

If there is a high risk of mortality, angiography <96hours with a GIIb/IIIa receptor antagonist (eptifibatide)

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16
Q

What are the conservative, medical and surgical management strategies for someone with chronic ACS?

A

Conservative: lifestyle factors, cardiac rehabilitation programmes, is bus/lorry inform DVLA

Medical: 5 A’s. Aspirin, Antiplatelet, ACE, Atenolol, Atorvastatin

Surgical: coronary artery bypass graft

17
Q

What drug can cause an oculogyric crisis and what drug can be used to treat this?

A

Metoclopramide

Procyclidine

18
Q

What is Dressler’s syndrome and what do the investigations of it show?

A

A subtype of pericarditis
Immune response after trauma to the heart tissue or pericardium
Seen 2-6 weeks post MI sometimes

Raised ESR, pleuritic chest pain, pericardial rub, ST elevation

Use NSAIDs to treat

19
Q

How does a left ventricular aneurysm present?

A

Can be 4-6 weeks post MI. Due to weakening of the myocardium.

Presents with pulmonary oedema and ST elevation in anterior leads. A thrombus may form within the aneurysm. This can lead to a stroke

Anticoagulate

20
Q

How does post-MI cardiac tamponade present and what is the management?

A

Beck’s triad: hypotension, raised JVP, muffled heart sounds
Pulsus paradoxus present

Use pericardiocentesis to manage

21
Q

What tests do you do in suspected ACS?

A

ECG
CXR: look for cardiomegaly, pulmonary oedema
Bloods: FBC, U&E, glucose, lipids, cardiac enzymes

22
Q

Outline the cardiac enzymes

A

Myoglobin is the first to rise

Troponins I and T are the most specific to the heart and myocardial damage (can also be raised with other things)

CK, CK-MB and AST also raised in response to a MI. CK-MB is useful to look for reinfarction as it returns to normal after 2-3 days

23
Q

What are the CI to thrombolysis in patients with ACS?

A

Previous intracranial haemorrhage
Ischaemic stroke <6m
Cerebral malignancy
Aortic dissection

24
Q

What is the long term pharmacological management of someone who presents with ACS?

A

2 antiplatelets: aspirin and clopidogrel for 12m
Anticoagulate with fondaparinux until discharge
Beta blocker: reduces myocardial oxygen demand
ACEi in patients with hypertension or diabetes
Atorvastatin 80mg

25
Q

Which patients must receive a CT angiography?

A

STEMI patients and very high risk NSTEMI patients (GRACE >120) should receive angiography and/or PCI.

26
Q

What driving advice do you give to patients who have had an ACS?

A

Driving: Group 1: can resume driving 1wk after successful angioplasty, or 4wks after ACS without successful angioplasty.

Group 2: must inform the DVLA and stop driving. May be able to start after 6 weeks.

27
Q

What is the emergency management of a pulmonary embolus?

A

1) If hypoxic, oxygen 10-15L/min
2) Morphine 5-10mg IV with metoclopramide
3) LMWH/Fondaparinux
4) If decreased BP give 500mL bolus

5)
If haemodynamically stable, LMWH
If hypotensive, thrombolyse (alteplase)
If haemodynamically unstable, give dobutamine or noradrenaline

6) Long term anticoagulation

28
Q

What are the investigations for a PE?

A

ECG (see other flashcard for signs)
CXR
ABG (hyperventilation)
Serum D dimer (low specificity, can be increased by thrombosis, inflammation, infection and malignancy)
CTPA (gold standard). If unavailable, do a V/Q scan

29
Q

Outline what happens in a thoracic aortic dissection and the signs of it

A

Blood splits the aortic media with sudden tearing chest pain and radiation to back.
Hemiplegia, unequal arm pulses, acute limb ischaemia, paraplegia,

Type A: ascending aorta (70%). SURGERY.
Type B: anywhere else.

30
Q

What is the emergency management of an aortic dissection?

A

Crossmatch 10u blood.
ECG, CXR
CT or TOE
Hypotensives: keep systolic at 100-110. Labetalol.

31
Q

What are the indications for a CABG?

How does a CABG work?

A

Left main stem disease or triple vessel disease
Angina unresponsive to drugs
Unstable angina
If angioplasty is unsuccessful

The patients own saphenous vein or internal mammary artery are used as the graft. Cardiac bypass surgery needed.

32
Q

If you have a strong suspicion that a patient has a PE but there is a delay in the CTPA occurring, what do you do?

A

Give LMWH while waiting for the scan

33
Q

If a patient has a PE and renal impairment, what is the most appropriate initial investigation?

A

Ventilation perfusion scan

Cardio (10 decks)

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