Chest pain Flashcards
What valvular conditions can cause chest pain?
Aortic stenosis and mitral valve prolapse
What is takotsubo cardiomyopathy? When does it occur?
Sudden LV dysfuntion + MI symptoms with absence of significant CAD. Usually transient. Triggered by extreme stress.
What presentation in women should you rule out ACS in?
GORD
Life threatening causes of chest pain
MI
PE
Pneumothorax
Cardiac tamponade
Myocarditis/pericarditis
Oesopageal rupture -> mediastanitis
Achalasia
loss of oesophageal peristalsis and failure of the lower oesophageal sphincter to relax in response to swallowing
Further investigations to use after bloods and CXR for chest pain
TOE may be utilized in certain scenarios
CTCA/CTA/CTPA
V/Q scan
Cardiac catherisation and angiogram
Myocardial perfusion imaging scan
What is it important to repeat in ACS patient?
ECG half an hour after initial one to look for changes
Cardiac biomarkerd - Tropoin T, repeat after one hour then after 3
What level of Troponin T rules out ACS?
<5ng/L >6 hours since symtpoms started
What level of Troponin T do you treat as ACS immediately?
> 14ng/L
What investigation should you do to exclude other causes of chest pain aswell as look for signs of HF
CXR - PE, pneumothorax etc
What complications of MI can ECHO pick up?
ventricular dysfunction, mural thrombus, papillary muscle rupture, mitral regurgitation, pericardial effusion
Complications post ACS pneumonic
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
What causes stable angina?
Blood clot causes partial blockage of a major coronary artery and ↓blood flow.
How is acute chest discomfort often described?
Tightness
Pressure
Pain
Burning
What pain can be mistaken for chest pain?
Dyspnoea
Epigastric pain
Pain in left arm, jaw
Vascular causes of chest pain
Stable angina
MI/ACS
Aortic dissection
Aortic aneurysm
Symptoms of aortic dissection
- 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.
Cardiac causes of chest pain
- Pericarditis
- Myocarditis
- Cardiac tamponade
- Takutsobo cardiomyopahty
- Valvular
- Aortic stenosis
- Mitral valve prolapse
Resp causes of chest pain
- PE
- Pneumonia
- TB
- Bronchospasm
- Malignancy
- Asthma
COPD flare
PULMONARY OEDEMA
Pleuritis
Other causes of chest pain
Cholecystisis, angitis
Cocaine abuse
Anxiety and panic disorders
Herpes zoster
Neuropathic pain
Thoracic radiculopathy
Thoracic outlet syndrome
Costochonditis
Shingles
GORD
Peptic ulcer disease
MSK
Common causes of chest pain
- PE
- Pneumonia
- TB
- Bronchospasm
- Malignancy
- Asthma
PMH in chest pain
- HPTN
- Hyperlipidemia
- Diabetes
- Prev MI/stroke
- Prev PCI/CABG
- FH of cardiac disease - significant event in under 65
- Smoking
Types of resp chest pain
- Constant, severe + dull = malignancy
- Shoulder = referred from diaphragm, left sided cancer
- Localised sharp = pleuritic pain = PE, pneumonia, pneumothorax
What to cover in a targeted general exam for chest pain?
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.
What do rales and dullness on auscultation often suggest?
LHF
What are rales
Small clicking, bubbling, or rattling sounds in the lungs
What abdo problems could be casuing radiated chest pain from RUQ?
Liver or gallbladder pathologies
What is Becks triad?
- Low BP
- Muffled Heart sounds
- Jugular vein ditensions
What is Becks triad suggestive of?
Cardiac tamponade
What is a TOE?
Transoesophageal ECHO
Further investigations for chest pain
TOE
CTCA, CTA, CTPA
V/Q scan
Cardiac catheterisation and angiogram
Myocardial perfusion imaging scan
What are the indications for: TOE
CTCA, CTA, CTPA
V/Q scan
Cardiac catheterisation and angiogram
Myocardial perfusion imaging scan
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What is needed for a diagnosis of ACS?
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
Causes of angina
Primary - atherosclerosis
Coronary artery vasospasm
