chest pain Flashcards
what to include on examinations?
VINIDCATE
v- vascular
i - infection
N - neoplasm
D- degenerative/ drugs
I - iatrogenic
C - congenital
A - autoimmune
T - trauma
E - endocrine/ metabolic
how do you assess pain?
SOCRATES
S- site
O - onset
C - character
R - radiation
A - associations
T - time course
E - exacerbating
S - severity
how do you assess pain?
SOCRATES
S- site
O - onset
C - character
R - radiation
A - associations
T - time course
E - exacerbating
S - severity
what are vascular suspicions?
vascular big 3 - ACS, PE, AAS
define aortic dissections
A tear in the aorta resulting in separation in the intima layer, causing blood flow into new channel composed of inner and outer layers of media
40% of patients with aortic dissections die instantly, why?
linked to aortic rupture, tamponade, heart failure, end organ perfusion (brain and kidneys)
What are risk factors for an aortic dissection?
hypertension
connective tissue disorders (ehlers- dandlos)
aortic vasculitis
pre-existing aneurysms
what is aortic vasculitis?
inflammation of blood vessels
describe the pain in aortic dissections?
tearing pain, worst pain experienced
radiate from chest to back and even abdo
sudden onset
apart from pain what are other symptoms of aortic dissections?
left/ right blood pressure differential
associated with syncope and sudden collapse
X ray - shows widened mediastinum
what is type A aortic dissections?
aortic regurgitation
difference in blood pressure
tear in ascending aorta
what is the treatment in type A aortic dissections?
b blocker, non- dihydropyridine CCB, opioid analgesics
surgical - root repair/ grafting, open surgery/ endovascular repair
what is type B aortic dissections?
tear in lower descending aorta
may extend to abdo
what is treatment in type B aortic dissections?
emergency - rapid b blocker (labealol)
medical - anti-hypertensives
lifestyle and risk factor management
some patients may require stenting
what is the best diagnostic tool for aortic dissections?
CT - highly diagnostic accuracy and widespread availability
define pericarditis?
inflammation of pericardium, the acute form is the new-onset inflammation lasting <4- 6 weeks
what are signs of pericarditis?
ST elevation - saddle shape
viral/bacterial - infection
aggravated by deep breathing
influenced by changes in body position - lying makes it worse
pericardial rub
what does pericardial rub sound like?
superficial scratchy/ squeaking sound
best heard of diaphragm
heard o left sternal edge with patient leaning forward
repeat multiple times as can change over several hours
patient to hold breath
what is the aetiology of pericarditis?
constricitive pericarditis impedes normal diastolic filling
complication of acute pericarditis
what are the risk factors for pericarditis?
cocaine
male
occurs more in younger people than a MI
what are the treatments of pericarditis?
NSAIDs with PPI
aspirin
cholchine - helps with inflammation
define myocarditis
infection of the heart causing inflammation to myocardium in the absence of the predominant acute or chronic ischaemia characteristic of CAD
what is the myocarditis aetiology?
often due to infection by common virus (parovirus B19, adenovirus, COVID) could be less common eg lyme disease
what are the symptoms of myocarditis?
med Hx - recent viral infection including fever, rash, diarrhoea, sore throat, joint pain
raised C - reactive protein released by liver
saddle shaped ST elevation
what can often be seen with pericarditis?
myocarditis - myopericarditis
what are risk factors for myocarditis?
HIV infection, auto-immune mediated diseases, peripartrum and postnatal periods
what is treatment of myocarditis?
supportive care, conventional heart failure therapy
severe cases - mechanical conventional therapy/ heart transplant
most cases are symptomatic and recover themselves
define costochondritis
inflammation and swelling of cartilage between rib and breastbone
what are the symptoms of chostochondritis?
superficial chest pain, muscular tender pain when pressed
can be aggravated by intense exercise if not previously used it
may present as angina type pain
pain localised but may radiate to arms/ shoulder
what past medical history may trigger costochondritis?
persistent cough/ sneezing/ vomiting can cause strain - recent illness
what are risk factors for costrochondritis?
microtrauma, female, Hispanic ethnicity, >40yrs
what is a differential diagnosis in females for costrochondritis?
often missed in females - diagnosed as mastitis pain
