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Year 3 > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

What is the breakdown of Ischaemic Heart disease categories?

A

Vasospastic = Prinzmetal Angina
All else atherosclerotic

Then stable angina or ACS
ACS broken into unstable angina and STEMI and NSTEMI

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2
Q

RFs for IHD?

A 
HTN
Smoking
Diabetes
FHx
PMHx
Hyperlipidaemia
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3
Q

Stable angina presentation, Ix and management?

A

Normal on resting examination
Bloods = lipids, FBC and glucose
ECG

Conservative: weight loss, improved diet and smoking cessation

Medical:

  • GTN- repeat after 5mins, call ambulance if not relieved after 5 mins
  • anti-anginals: BB/CCB

Manage RF:

  • ACEi (if diabetics)
  • antiplatelets- aspirin 75mg
  • statins
  • anti-hypertensive Tx in line with guidelines
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4
Q

Unstable and NSTEMI ECG features?

A

Normal, inverted T waves or ST depression

NSTEMI has elevated troponin

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5
Q

ACS signs and symptoms?

A 
Acute central chest pain (grip[png or heavy) +/- radiation to neck,arm,jaw
Sweating
Pallor
\+/- SOB
CAN BE SILENT IN OLD or DM
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6
Q

ACS Ix?

A

ECG and troponins

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7
Q

Coronary anatomy and ECG leads?

A

Septal: V1, V2 = LAD
Anterior: V3, V4 = LAD
Lateral: I, aVL V5, V6 = LCx or diagonal of LAD
Inferior: 2, 3, aVF = RCA and or LCx

Anterolateral MI = V1-V6 - LCA
Posterior MI = ST depression in V1-V4 = posterior descending (branch of LCx)

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8
Q

ECG changes in STEMI?

A

Hyperacute T waves

ST elevation and new LBBB

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9
Q

Old infarct ECG feature?

A

Pathological Q waves

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10
Q

STEMI management?

A
  • <12hrs and PCI in <2 hours = PCI
  • <12hours but PCI not available <2 hours = thrombolysis- alteplase (+anti-thrombin eg Warfarin)
  • > 12hours since onset = coronary angiography + possible PCI (if evidence of ongoing ischaemia)

Management:
Immediate = morphine, oxygen, nitrates, aspirin + clopidogrel (dual anti platelet therapy)

Long =

  • BB
  • ACEi
  • Statin
  • Aspirin + clopidogrel
  • Rivaroxaban
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11
Q

NSTEMI management?

A

Same as STEMI but LMWH

Determine risk via GRACE score: low = angiography
Moderate high = angiography + aim for PCI within 72hrs

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12
Q

STEMI Complications?

A 
DARTH VADER
Death
Arrhythmia
Rupture
Tamponade
HF
Valve disease
Aneurysm
Dresslers syndrome
Embolism
Reinfarction
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13
Q

Causes of pericarditis?

A

ABCDIVM

Autoimmune e.g. SLE, RA
Bacterial e.g. pneumococcus, staph, strep
Connective tissue e.g. sarcoidosis
Dressler syndrome (2-10 week post MI

Idiopathic
Viral e.g. Coxsacki, mumps, EBV
Malignancy

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14
Q

RFs for pericarditis?

A 
Male 
20-50
transmural MI
cardiac surgery
neoplasm 
uraemia or dialysis
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15
Q

Pericarditis signs and symptoms?

A

SHarp, stabbing pleuritic chest pain

  • relieved leaning forward
  • radiate to trapezius ridge

Coryzal Symptoms if viral
pericardial friction rub
Tamponade = becks triangle (muffled heart sounds, hypotension, neck vein distension)

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16
Q

What is becks triangle?

NBM

A

distended Neck veins
low arterial BP
Muffled heart sounds

Indicate tamponade and constrictive pericarditis

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17
Q

Pericarditis Ix?

A

ECG showing widespread saddle shaped ST elevation
Or widespread PR depression
Spodicks sign (downsloping TP segment)

Bloods and CXR for pericardial effusion

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18
Q

Pericarditis management?

A

NSAID + PPI + Cochicine + exercise restriction if viral

Tamponade or purulent = pericardiocentesis + AB as well as above

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19
Q

Complication of pericarditis?

A

Pericardial effusion +/- tamponade

Chronic constrictive pericarditis

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20
Q

Categories of syncope?

A

1) Cardiac (arrhythmia related) -due to CO compromise e.g. VT or heart block
2) Cardiac (structural heart disease) = most notably LV outflow obstruction (HOCM, sevre AS, PE, aortic dissection)
3) Orthosatic
4) Reflex (reflex vasodilation/bradycardia due to trigger e.g. vasovagal or carotid sinus syncope)

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21
Q

How to differentiate syncope types?

A

1) establish LOC with no seizures
2) determine cardiac red flag symptoms
3) Ix
ECG, imaging for PE or aortic dissection, ECHO for cardiac syncope. BP for orthostatic
Negative IX = orthostatic

22
Q

What are the cardiac red flags?

A

LOC during exertion
Severe valvular disease
Previous arrhythmia
Concerning ECG

23
Q

RFs for vasovagal syncope?

A

Prior syncope, emotional stress, prolonged straining, heat and excessive dehydration

24
Q

Presentation, Ix and management of vasovagal syncope?

A

Nausea, pallor, light headed, diminished hearing/vision. physical injury

ECG and bloods

Patient education on triggers with physical counter pressure manouevres

25
Q

RFs for AF?

A

HTN, heart failure, diabetes, obesity, alcohol use and hyperthyroid

26
Q

Causes of AF?

A

Idiopathic, coronary artery disease, thyroid, COPD< electrolyte disturbance and pneumonia

27
Q

Types of AF?

A

Paroxysmal AF terminates within 7 days

Persistent AF terminates after 7 days

28
Q

AF signs and investigations?

A

Palpitations, irregularly irregular pulse rate, sob and chest pain

ECG showing Irrgularly irregular with no p waves
Bloods
CXR and TTE for valve disease

29
Q

Complications of AF?

A

Thromboembolism or worsened HF

30
Q

How to treat AF?

A

<48 hours and haemodynamically stable = Rhythm control = DC cardioversion or chemical (fleicanide/amiodarone)

> 48 hours + haemodynamically stable = anticoagulation with LMWH + warfarin, rate control- bisoprolol or verapamil/diltizem/digoxin

If haemodynamically unstable = DC cardioversion

CHADSVASC >2 = long term warfarin

31
Q

Atrial flutter causes and ECG + symptoms?

A

Underlying heart conditions causing
Saw tooth pattern with loss of isolelectric baseline and p waves

Same signs, symptoms and management as AF

32
Q

Causes of heart block?

A 
MI/IHD
infection = rheumatic fever
Drugs e.g. beta blockers, CCB, amiodarone
Metabolic = hyperkalaemia, low T4
Sarcoidosis
33
Q

Signs and symptoms of heart block?

A

1st and 2nd type 1 = asymptomatic
2nd type 2 and 3rd = dizzy, palpitations, chest pain and heart failure

May have stokes-adams attacks which are syncope due to ventricular asystole

34
Q

Ix for Heart block?

A

ECG, troponins, K+, Ca2+, pH, digitalis toxicity and echo

35
Q

Management for heart block?

A

Chronic = pacemake for mobitz 2 for 3rd degree

Acuet 2nd to MI = IV atropine and external pacemaking

36
Q

Complications of heart block?

A

Asystole, heart faliure and cardiac arrest

37
Q

SVT signs and symptoms + types?

A

Regular narrow complex tachycardia with no p waves >100bpm

AVRT = accesory pathway from ventricles back to atria
AVNRT = accesory pathway from AV node to atria (bundle of kent in WPW)

Palpitations
Syncope
SOB and CHest pain

38
Q

SVT Ix and management?

A

ECG and bloods

Vagal manouvres, adenosine and ablation

Digoxin and verapmil containdicated in AVRT
NO adenosine in astma so use verapamil

39
Q

VT ECG changes, causes and Ix?

A

Regular ,wide complex tachycardia with no p waves

Long QT syndrome, electrolyte imbalance or illicit drugs

ECG and bloods

40
Q

VT signs and symptoms?

A

Chest pain, dizziness, fainting, sudden death, pallor and hypotension

41
Q

Management of VT?

A 
Stable = amiodarone 300mg IV
Unstable = DC cardioversion
42
Q

Type of polymorphic VT and how to remove QT prolongation?

A

Torsades de Pont

Magnesium and phenytoin

43
Q

VF causes?

A

MI, increased catecholamines, electrolyte imbalance, hypoxia, acid-base distribance, hyper or hypothermia and congenital conditions e.g. QT syndrome or brugada

ACCEHHM

44
Q

SS of VF and Ix?

A

Chest pain, dizzy, sob and unconscious

Time dependent Ix but ECG and bloods

45
Q

Managment of VF?

A

Commense CPR/cardiac arrest protocol immediately

IV adrenaline and iv amiodarine after 3 shocks.
Treat reversible causes: 4 Hs and 4Ts

46
Q

4Hs and Ts of Cardiac arrest

A 
Hyperkalaemia
Hypo/hyperthermia
Hypovolaemia
Hypoxia
Tension pneumothorax
Tamponade
Toxic
Thromboembolism
47
Q

Causes of WPW?

A 
EBSTEINS ANOMAL
heart defect e.g VSD, dextrocardia, great vessel transpostition
mitral valve prolapse
coarctation of aorta
Marfans
48
Q

SS of WPW?

A

Palpitations, dizzy, chest pain, SOB

49
Q

WPW Ix?

A

ECG showing sluured upstroke (delta wave) on with short PR

ECHO for structural disease

50
Q

Management of WPW?

A 
Unstable = DC cardioversion
Stable = vagal mouvres -> IV adenosin -> DC cardiovert

Long term = ablation or anti-arrhythmic = amiodarone,procainamide

51
Q

Complications opf WPW?

A

Sudden cardiac death

Ablation SE e.g. bleeding, infection, pneumothorax

Year 3 (38 decks)

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