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Year 3 Cardio > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

What are some investigations for Chest pain?

A

ECG
Exercise ECG
Troponin
Cardiac angiogram

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2
Q

How do you assess for ST depression?

A

Compare ST segment to the PR interval

Is it above or below?

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3
Q

What is the likely diagnosis for ST depression?

A

Angina

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4
Q

What is chronic stable angina?

A

Partly blocked coronary artery
When HR rises ischaemia becomes significant
Lactate accumulates due to switch to anaerobic respiration

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5
Q

What drugs are used to treat chronic stable angina?

A

Asprin
Nitrates
Beta blockers: Atenolol
Statins

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6
Q

What are the characteristic presentation of chronic stable angina?

A

Exertional chest pain relieved at rest

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7
Q

What coronary artery is involved when ST depression is seen in leads V4,V5,V6?

A

Antero-lateral view of heart
Left coronary artery which supplies the anterior wall
If also involves V6 - goes round (lateral)

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8
Q

Why are beta blockers used?

A

Slow heart down

Reduces anaerobic respiration

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9
Q

What nitrates are used? Why?

A

GTN dilates the coronary artery
Isosorbide mononitrate is long acting, tablet 2x day
But develop tolerance

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10
Q

What is the surgical management for Coronary artery disease?

A

CABG
Angiogram - see where the blocks are
Angioplasty - put a wire in artery and blows up balloon

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11
Q

Describe the development of atherosclerosis

A 
Normal
Fatty streak
Plaque
Increasing plaque
Obstructive atherosclerotic plaque
Plaque fissure or erosion
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12
Q

What is the diagnosis when there is ST elevation in leads V2 and V3?

A

Anterior STEMI

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13
Q

ST elevation in leads II, III and aVF?

A

Inferior STEMI

Right coronary artery occlusion

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14
Q

What is the management for a heart attack?

A

Unblock the coronary artery
PCI - percutaneous coronary intervention
Angioplasty
Door to needle time should be under 30 minutes

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15
Q

What happens if immediate angioplasty is unavailable?

A

Thrombolysis with tPA e.g. altepase
Asprin and nitrates
Betablockers
Statin

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16
Q

What is the definitive management for a STEMI?

A

PCI = Angioplasty with stent

17
Q

How do we manage cardiovascular risk?

A 
Diet and exercise 
Stop smoking
Reduce BP, low salt
Drug treatments
Drop lipids
18
Q

Summarise antihypertensive drug treatment

A

ACE inhibitor or low cost ARB
CCB
Thiazide-like diuretic

19
Q

What demographic factors effect hypertensive treatment

A

Age > 55 years

Black origin

20
Q

Should you accept a SBP of 140 on just atenolol treatment?

A

Adding Thiazide you get a absolute reduction of 2%

21
Q

What is a PCSK9 inhibitor?

A

Proprotein convertase substilisn kexin 9

Controls having too much LDL receptor

Inhibiting lowers cholesterol

22
Q

Define myocarditis

A

Inflammation of the myocardium in the absence of the predominant acute or chronic ischaemia characteristic of coronary artery disease

23
Q

When especially should myocarditis be considered as a differential?

A

Young person presenting with acute chest pain
Dypnoea
Arrhythmias
Viral prodome

24
Q

What are some causes of myocarditis?

A

viral: coxsackie B, HIV
bacteria: diphtheria, clostridia
spirochaetes: Lyme disease
protozoa: Chagas’ disease, toxoplasmosis
autoimmune
drugs: doxorubicin (cytotoxic antibiotic)

25
Q

What would you see on bloods in myocarditis?

A

Raised inflammatory markers
Raised cardiac enzymes
Raised BNP
Mildly elevated CK

26
Q

What ECG changes would be seen in myocarditis?

A

Tachycardia
Arrhythmias
ST elevation
T wave inversion

27
Q

What is the treatment for myocarditis in a haemodynamically stable patient?

A

Supportive and treat underlying cause

28
Q

What is the treatment for myocarditis if there is evidence of LV systolic dysfunction?

A

ACEi or ARBs

Ramipril or Losartan/Irbesartan

Year 3 Cardio (12 decks)

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