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Cardiovascular > chest pain > Flashcards

chest pain Flashcards

1
Q

what to include on examinations?

A

VINIDCATE
v- vascular
i - infection
N - neoplasm
D- degenerative/ drugs
I - iatrogenic
C - congenital
A - autoimmune
T - trauma
E - endocrine/ metabolic

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2
Q

how do you assess pain?

A

SOCRATES
S- site
O - onset
C - character
R - radiation
A - associations
T - time course
E - exacerbating
S - severity

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3
Q

how do you assess pain?

A

SOCRATES
S- site
O - onset
C - character
R - radiation
A - associations
T - time course
E - exacerbating
S - severity

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4
Q

what are vascular suspicions?

A

vascular big 3 - ACS, PE, AAS

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5
Q

define aortic dissections

A

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

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6
Q

40% of patients with aortic dissections die instantly, why?

A

linked to aortic rupture, tamponade, heart failure, end organ perfusion (brain and kidneys)

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7
Q

What are risk factors for an aortic dissection?

A

hypertension
connective tissue disorders (ehlers- dandlos)
aortic vasculitis
pre-existing aneurysms

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8
Q

what is aortic vasculitis?

A

inflammation of blood vessels

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9
Q

describe the pain in aortic dissections?

A

tearing pain, worst pain experienced
radiate from chest to back and even abdo
sudden onset

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10
Q

apart from pain what are other symptoms of aortic dissections?

A

left/ right blood pressure differential
associated with syncope and sudden collapse
X ray - shows widened mediastinum

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11
Q

what is type A aortic dissections?

A

aortic regurgitation
difference in blood pressure
tear in ascending aorta

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12
Q

what is the treatment in type A aortic dissections?

A

b blocker, non- dihydropyridine CCB, opioid analgesics
surgical - root repair/ grafting, open surgery/ endovascular repair

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13
Q

what is type B aortic dissections?

A

tear in lower descending aorta
may extend to abdo

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14
Q

what is treatment in type B aortic dissections?

A

emergency - rapid b blocker (labealol)
medical - anti-hypertensives
lifestyle and risk factor management
some patients may require stenting

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15
Q

what is the best diagnostic tool for aortic dissections?

A

CT - highly diagnostic accuracy and widespread availability

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16
Q

define pericarditis?

A

inflammation of pericardium, the acute form is the new-onset inflammation lasting <4- 6 weeks

17
Q

what are signs of pericarditis?

A

ST elevation - saddle shape
viral/bacterial - infection
aggravated by deep breathing
influenced by changes in body position - lying makes it worse
pericardial rub

18
Q

what does pericardial rub sound like?

A

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

19
Q

what is the aetiology of pericarditis?

A

constricitive pericarditis impedes normal diastolic filling
complication of acute pericarditis

20
Q

what are the risk factors for pericarditis?

A

cocaine
male
occurs more in younger people than a MI

21
Q

what are the treatments of pericarditis?

A

NSAIDs with PPI
aspirin
cholchine - helps with inflammation

22
Q

define myocarditis

A

infection of the heart causing inflammation to myocardium in the absence of the predominant acute or chronic ischaemia characteristic of CAD

23
Q

what is the myocarditis aetiology?

A

often due to infection by common virus (parovirus B19, adenovirus, COVID) could be less common eg lyme disease

24
Q

what are the symptoms of myocarditis?

A

med Hx - recent viral infection including fever, rash, diarrhoea, sore throat, joint pain
raised C - reactive protein released by liver
saddle shaped ST elevation

25
Q

what can often be seen with pericarditis?

A

myocarditis - myopericarditis

26
Q

what are risk factors for myocarditis?

A

HIV infection, auto-immune mediated diseases, peripartrum and postnatal periods

27
Q

what is treatment of myocarditis?

A

supportive care, conventional heart failure therapy
severe cases - mechanical conventional therapy/ heart transplant
most cases are symptomatic and recover themselves

28
Q

define costochondritis

A

inflammation and swelling of cartilage between rib and breastbone

29
Q

what are the symptoms of chostochondritis?

A

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

30
Q

what past medical history may trigger costochondritis?

A

persistent cough/ sneezing/ vomiting can cause strain - recent illness

31
Q

what are risk factors for costrochondritis?

A

microtrauma, female, Hispanic ethnicity, >40yrs

32
Q

what is a differential diagnosis in females for costrochondritis?

A

often missed in females - diagnosed as mastitis pain

Cardiovascular (14 decks)

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