Chest Pain Flashcards
What are the causes of chest pain?
- Non Cardiac (Pulmonary, pleuritic, PE, traumatic, musculoskeletal → e.g. Marfan’s syndrome in TALL individuals, arthritic, Upper GI, etc.) → if have autoimmune disease then INCREASE risk of coronary heart disease (as autoimmune)
- Aortic (Aneurysm/dissection → when chest pain going from heart to BACK)
-
Pericardial / Valvular
-
Pericarditis → pain on INSPIRATION & EXPIRATION
- LESS pain when sitting forward & WORSE whenlying down(as MORE rubbing), HIGHER risk with diabetic nephropathy
-
Pericarditis → pain on INSPIRATION & EXPIRATION
- Cardiac – Stable → knows when happens v Unstable → when have HYPOTENSION & wakes up at night
- Acute Coronary Syndromes (STEMI, nonSTEMI, unstable angina, arrhythmia, sudden death)
Is blood pressure equal in both arms?
People have HIGHER BP in the right arm by 10mmHg because right brachiocephalic branches off first
What is an aortic aneurysm? (location, cause, complications)
Abnormal dilatation of Aorta (usually SLOW and PROGRESSIVE)
Location:
Thoracic / Abdominal
Causes : Degenerative, HIGH BP, Arteritis, Connective tissue diseases, Bicuspid AV, Family history
Usually asymptomatic incidental finding on CXR/CT
Severe sharp back/interscapular pain
Complications: Dissection, rupture, AV regurgitation
Surveillance, Repair, Replacement
Draw what aortic aneurysm & dissection and WHERE they often happen
Why and where would thoracic aneurysms happen?
What is the classification of aortic dissections? (which type is most sever)
Type A is most serious
Where do the vertebral arteries come off?
The vertebral arteries ALL come off the subclavian arteries
What are the first steps to do to someone with chest pain?
- Assess patient
- Stabilise
- Oxygen → 15L non-rebreathe mask
- IV cannula → 1L/15mins & IV paracetamol
- Analgesia → morphine 2.5-5mg
- Re-assure
What causes us to vomit?
- BRAIN - chemoreceptor trigger zone that causes vomiting
What to ask someone in the history (about chest pain)?
- Site
- Duration
- Severity
- Radiation
- Relation to activity
- Associated autonomic factors
- Aggravating / Relieving factors
- Pattern – if any (nocturnal/decubitis angina)
- Previous history of similar problems / risk factor assessment
What are the risk factors for coronary heart disease?
- Non-modifiable – Age, Gender, Family history, previous CHD event
- Modifiable – Lifestyle, BMI, Smoking, DM, BP, Lipids, Stress
- Often inter-related and additive
- Underlying Atherosclerosis
What investigations would you do in someone with chest pain?
- ECG (Normal / STEMI / non STEMI / ST depression / non-specific changes)
- CXR
- ABG +
- Blood tests – FBC, renal, cardiac enzymes, Lipids, TFT +
- Repeat ECG / enzymes
- ECHO / ETT (exercise therapy test) / MPS (myocardial perfusion scan) / CTCA (CT coronary arteries)/ Angiography / MRI
What is this an example of?
Explain and draw the electrical conduction system of the heart
Explain a normal ECG wave
