Chest Pain Flashcards
What are some investigations for Chest pain?
ECG
Exercise ECG
Troponin
Cardiac angiogram
How do you assess for ST depression?
Compare ST segment to the PR interval
Is it above or below?
What is the likely diagnosis for ST depression?
Angina
What is chronic stable angina?
Partly blocked coronary artery
When HR rises ischaemia becomes significant
Lactate accumulates due to switch to anaerobic respiration
What drugs are used to treat chronic stable angina?
Asprin
Nitrates
Beta blockers: Atenolol
Statins
What are the characteristic presentation of chronic stable angina?
Exertional chest pain relieved at rest
What coronary artery is involved when ST depression is seen in leads V4,V5,V6?
Antero-lateral view of heart
Left coronary artery which supplies the anterior wall
If also involves V6 - goes round (lateral)
Why are beta blockers used?
Slow heart down
Reduces anaerobic respiration
What nitrates are used? Why?
GTN dilates the coronary artery
Isosorbide mononitrate is long acting, tablet 2x day
But develop tolerance
What is the surgical management for Coronary artery disease?
CABG
Angiogram - see where the blocks are
Angioplasty - put a wire in artery and blows up balloon
Describe the development of atherosclerosis
Normal Fatty streak Plaque Increasing plaque Obstructive atherosclerotic plaque Plaque fissure or erosion
What is the diagnosis when there is ST elevation in leads V2 and V3?
Anterior STEMI
ST elevation in leads II, III and aVF?
Inferior STEMI
Right coronary artery occlusion
What is the management for a heart attack?
Unblock the coronary artery
PCI - percutaneous coronary intervention
Angioplasty
Door to needle time should be under 30 minutes
What happens if immediate angioplasty is unavailable?
Thrombolysis with tPA e.g. altepase
Asprin and nitrates
Betablockers
Statin
What is the definitive management for a STEMI?
PCI = Angioplasty with stent
How do we manage cardiovascular risk?
Diet and exercise Stop smoking Reduce BP, low salt Drug treatments Drop lipids
Summarise antihypertensive drug treatment
ACE inhibitor or low cost ARB
CCB
Thiazide-like diuretic
What demographic factors effect hypertensive treatment
Age > 55 years
Black origin
Should you accept a SBP of 140 on just atenolol treatment?
Adding Thiazide you get a absolute reduction of 2%
What is a PCSK9 inhibitor?
Proprotein convertase substilisn kexin 9
Controls having too much LDL receptor
Inhibiting lowers cholesterol
Define myocarditis
Inflammation of the myocardium in the absence of the predominant acute or chronic ischaemia characteristic of coronary artery disease
When especially should myocarditis be considered as a differential?
Young person presenting with acute chest pain
Dypnoea
Arrhythmias
Viral prodome
What are some causes of myocarditis?
viral: coxsackie B, HIV
bacteria: diphtheria, clostridia
spirochaetes: Lyme disease
protozoa: Chagas’ disease, toxoplasmosis
autoimmune
drugs: doxorubicin (cytotoxic antibiotic)
What would you see on bloods in myocarditis?
Raised inflammatory markers
Raised cardiac enzymes
Raised BNP
Mildly elevated CK
What ECG changes would be seen in myocarditis?
Tachycardia
Arrhythmias
ST elevation
T wave inversion
What is the treatment for myocarditis in a haemodynamically stable patient?
Supportive and treat underlying cause
What is the treatment for myocarditis if there is evidence of LV systolic dysfunction?
ACEi or ARBs
Ramipril or Losartan/Irbesartan
