Chest Pain Flashcards
Causes of chest pain
CARDIAC:
• CAD - ANGINA
• Aortic Valve Disease
• Pulmonary
Hypertension
• Mitral Valve Prolapse
• Pericarditis
• Hypertrophic CMO
• Myocarditis
VASCULAR:
• Aortic Dissection
• Aortic Aneurysm
PULMONARY:
• Pulmonary Embolism
• Pneumonia
• Pleuritis
• Pneumothorax
EMOTIONAL:
• Anxiety
• Depression
NEUROLOGICAL:
• Cervical Nerve Root
• Zoster
MUSCULOSKELETAL:
• Costochondritis
• Arthritis
• Muscular Spasm
• Bone Tumour
GASTRO-INTESTINAL:
• Peptic Ulcer
• GORD
• Pancreatitis
• Cholecystitis
Normal ECG
Pathophysiology of atherosclerosis
Risk factors for atherosclerosis
Describe angina
• Retrosternal pain
• Radiates down the left arm or into jaw
• Crushing or pressing in character
• Worsened by physical activity
• Better after nitrates or rest
Life threatening conditions that present as angina
1.Acute Coronary Syndrome
2.Acute Aortic Dissection
3.Pulmonary Embolism
4.Tension Pneumothorax
5.Pericardial Tamponade
6.Mediastinitis
Weird (atypical) symptoms can occur in the following patients with a heart attack
older patients, women, diabetics, patients with chronic
renal failure or dementia
Increased risk of MI
• Older age
• Male sex
• Positive family history
• Presence of peripheral vascular disease
• Presence of risk factors, esp. DM, CRF, previous MI or CABG
Acute coronary syndrome can present as
3 categories of patients with chest pain
STEMI
ACS – no ST elevation
ACS unlikely
Initial therapy of patient with chest pain
Acute coronary syndrome therapy antithrombotic
Inferior ST elevation MI
ST elevation MI in antroseptal
STEMI diagnosis treatment
PCI=percutaneous coronary intervention
NST elevation MI
NST elevation MI
Arrow head t-waves
NST elevation MI biomarkers
Cardiac troponins
Troponins are more specific and sensitive than traditional cardiac
enzymes. Repeat after 3 hours
An initial rise in troponins occurs within 4hrs after symptom onset.
Troponins may remain elevated for up to 2 weeks.
Elevated troponin differentials
Name an anticoagulant used for MI
Enoxapatin
Patients to consider for PCI
Summary of patient treatment
Reduce risk of MI
• STOP smoking
• Exercise regularly
• Healthy diet
• Lose weight
• Ways to cope with stress
Exercise effect on cardiac system
Drug therapy for MI
Cause of chronic angina
Gradual narrowing of lumen by plaque
Investigations for chronic chest pain
• ECG
• Effort stress test – diagnostic versus prognostic
• Full blood count
• Renal function
• Fasting blood glucose/HbA1c
• Fasting lipogram
• TSH
Chronic ishaemic heart disease, at rest
Patient with chronic ischemic heart disease when exercising
St depressions
Drugs for patient with chronic angina
• Aspirin
• Statin
• Beta-blocker/calcium channel antagonist
• Sublingual nitrates
• Probably ACE-inhibitor
If it persist
• Long-acting nitrates
• Vasodilatory CCBs such as amlodipine
• Ivabradine
And if still
• Revascularisation – surgical or percutaneous
