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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
RFs for AF?
HTN, heart failure, diabetes, obesity, alcohol use and hyperthyroid
26
Causes of AF?
Idiopathic, coronary artery disease, thyroid, COPD< electrolyte disturbance and pneumonia
27
Types of AF?
Paroxysmal AF terminates within 7 days | Persistent AF terminates after 7 days
28
AF signs and investigations?
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
Complications of AF?
Thromboembolism or worsened HF
30
How to treat AF?
<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
Atrial flutter causes and ECG + symptoms?
Underlying heart conditions causing Saw tooth pattern with loss of isolelectric baseline and p waves Same signs, symptoms and management as AF
32
Causes of heart block?
``` MI/IHD infection = rheumatic fever Drugs e.g. beta blockers, CCB, amiodarone Metabolic = hyperkalaemia, low T4 Sarcoidosis ```
33
Signs and symptoms of heart block?
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
Ix for Heart block?
ECG, troponins, K+, Ca2+, pH, digitalis toxicity and echo
35
Management for heart block?
Chronic = pacemake for mobitz 2 for 3rd degree | Acuet 2nd to MI = IV atropine and external pacemaking
36
Complications of heart block?
Asystole, heart faliure and cardiac arrest
37
SVT signs and symptoms + types?
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
SVT Ix and management?
ECG and bloods Vagal manouvres, adenosine and ablation Digoxin and verapmil containdicated in AVRT NO adenosine in astma so use verapamil
39
VT ECG changes, causes and Ix?
Regular ,wide complex tachycardia with no p waves Long QT syndrome, electrolyte imbalance or illicit drugs ECG and bloods
40
VT signs and symptoms?
Chest pain, dizziness, fainting, sudden death, pallor and hypotension
41
Management of VT?
``` Stable = amiodarone 300mg IV Unstable = DC cardioversion ```
42
Type of polymorphic VT and how to remove QT prolongation?
Torsades de Pont Magnesium and phenytoin
43
VF causes?
MI, increased catecholamines, electrolyte imbalance, hypoxia, acid-base distribance, hyper or hypothermia and congenital conditions e.g. QT syndrome or brugada ACCEHHM
44
SS of VF and Ix?
Chest pain, dizzy, sob and unconscious Time dependent Ix but ECG and bloods
45
Managment of VF?
Commense CPR/cardiac arrest protocol immediately IV adrenaline and iv amiodarine after 3 shocks. Treat reversible causes: 4 Hs and 4Ts
46
4Hs and Ts of Cardiac arrest
``` Hyperkalaemia Hypo/hyperthermia Hypovolaemia Hypoxia Tension pneumothorax Tamponade Toxic Thromboembolism ```
47
Causes of WPW?
``` EBSTEINS ANOMAL heart defect e.g VSD, dextrocardia, great vessel transpostition mitral valve prolapse coarctation of aorta Marfans ```
48
SS of WPW?
Palpitations, dizzy, chest pain, SOB
49
WPW Ix?
ECG showing sluured upstroke (delta wave) on with short PR | ECHO for structural disease
50
Management of WPW?
``` Unstable = DC cardioversion Stable = vagal mouvres -> IV adenosin -> DC cardiovert ``` Long term = ablation or anti-arrhythmic = amiodarone,procainamide
51
Complications opf WPW?
Sudden cardiac death | Ablation SE e.g. bleeding, infection, pneumothorax

Year 3 (38 decks)

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