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A- Resp and cardio > Chest pain > Flashcards

Chest pain Flashcards

1
Q

What valvular conditions can cause chest pain?

A

Aortic stenosis and mitral valve prolapse

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2
Q

What is takotsubo cardiomyopathy? When does it occur?

A

Sudden LV dysfuntion + MI symptoms with absence of significant CAD. Usually transient. Triggered by extreme stress.

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3
Q

What presentation in women should you rule out ACS in?

A

GORD

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4
Q

Life threatening causes of chest pain

A

MI
PE
Pneumothorax
Cardiac tamponade
Myocarditis/pericarditis
Oesopageal rupture -> mediastanitis

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5
Q

Achalasia

A

loss of oesophageal peristalsis and failure of the lower oesophageal sphincter to relax in response to swallowing

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6
Q

Further investigations to use after bloods and CXR for chest pain

A

TOE may be utilized in certain scenarios
CTCA/CTA/CTPA
V/Q scan
Cardiac catherisation and angiogram
Myocardial perfusion imaging scan

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7
Q

What is it important to repeat in ACS patient?

A

ECG half an hour after initial one to look for changes
Cardiac biomarkerd - Tropoin T, repeat after one hour then after 3

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8
Q

What level of Troponin T rules out ACS?

A

<5ng/L >6 hours since symtpoms started

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9
Q

What level of Troponin T do you treat as ACS immediately?

A

> 14ng/L

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10
Q

What investigation should you do to exclude other causes of chest pain aswell as look for signs of HF

A

CXR - PE, pneumothorax etc

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11
Q

What complications of MI can ECHO pick up?

A

ventricular dysfunction, mural thrombus, papillary muscle rupture, mitral regurgitation, pericardial effusion

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12
Q

Complications post ACS pneumonic

A

DARTH VADER
Death +/- cardiogenic shock
Arrhytmias - VT, VF, AV block
Ruptured mycoardium
Thrombus - cause 2nd MI
HF/hypertrophic LV/Hypotension
Ventricualr septal defect
Another MI
Dresslers syndrome - constrictive pericarditis that occurs 2-3 weeks post MI
Emboli
Regurgitation, mitral

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13
Q

What causes stable angina?

A

Blood clot causes partial blockage of a major coronary artery and ↓blood flow.

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14
Q

How is acute chest discomfort often described?

A

Tightness
Pressure
Pain
Burning

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15
Q

What pain can be mistaken for chest pain?

A

Dyspnoea
Epigastric pain
Pain in left arm, jaw

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16
Q

Vascular causes of chest pain

A

Stable angina
MI/ACS
Aortic dissection
Aortic aneurysm

17
Q

Symptoms of aortic dissection

A
  • a sudden onset of severe pain across the chest, often felt in the back or between the shoulder blades
  • pain in the jaw, face, abdomen, back or lower extremities
  • feeling cold, clammy and sweaty
  • fainting and shortness of breath.
18
Q

Cardiac causes of chest pain

A
  • Pericarditis
  • Myocarditis
  • Cardiac tamponade
  • Takutsobo cardiomyopahty
  • Valvular
    • Aortic stenosis
    • Mitral valve prolapse
19
Q

Resp causes of chest pain

A
  • PE
  • Pneumonia
  • TB
  • Bronchospasm
  • Malignancy
  • Asthma
    COPD flare
    PULMONARY OEDEMA
    Pleuritis
20
Q

Other causes of chest pain

A

Cholecystisis, angitis
Cocaine abuse
Anxiety and panic disorders
Herpes zoster
Neuropathic pain
Thoracic radiculopathy
Thoracic outlet syndrome
Costochonditis
Shingles
GORD
Peptic ulcer disease
MSK

21
Q

Common causes of chest pain

A
  • PE
  • Pneumonia
  • TB
  • Bronchospasm
  • Malignancy
  • Asthma
22
Q

PMH in chest pain

A
  • HPTN
  • Hyperlipidemia
  • Diabetes
  • Prev MI/stroke
  • Prev PCI/CABG
  • FH of cardiac disease - significant event in under 65
  • Smoking
23
Q

Types of resp chest pain

A
  • Constant, severe + dull = malignancy
  • Shoulder = referred from diaphragm, left sided cancer
  • Localised sharp = pleuritic pain = PE, pneumonia, pneumothorax
24
Q

What to cover in a targeted general exam for chest pain?

A

Volume status, hands, pallor, cyanosis, lymph nodes, arterial exam esp carotids, peripheral oedema, temp, BP - difference between arms, RR, O2 requirement, HR + radio-radial, radio-femoral delay.

25
Q

What do rales and dullness on auscultation often suggest?

A

LHF

26
Q

What are rales

A

Small clicking, bubbling, or rattling sounds in the lungs

27
Q

What abdo problems could be casuing radiated chest pain from RUQ?

A

Liver or gallbladder pathologies

28
Q

What is Becks triad?

A
  • Low BP
  • Muffled Heart sounds
  • Jugular vein ditensions
29
Q

What is Becks triad suggestive of?

A

Cardiac tamponade

30
Q

What is a TOE?

A

Transoesophageal ECHO

31
Q

Further investigations for chest pain

A

TOE
CTCA, CTA, CTPA
V/Q scan
Cardiac catheterisation and angiogram
Myocardial perfusion imaging scan

32
Q

What are the indications for: TOE
CTCA, CTA, CTPA
V/Q scan
Cardiac catheterisation and angiogram
Myocardial perfusion imaging scan

A

Look up adn add to flashcards

33
Q

What is needed for a diagnosis of ACS?

A

Detection of a cardiac biomarker, normally troponin T
At least one value above 99th percentile of one of:
-Symtpoms of MU
New ischaemic ECG change
Pathological Q waves develop
imaging - loss of viable myocardium/regional wallmotion abnormality
Intracoronary thrombus detected on angiography or autopsy

34
Q

Causes of angina

A

Primary - atherosclerosis
Coronary artery vasospasm

A- Resp and cardio (58 decks)

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