Chest pain

Question 1

What kind of chest pain do you get in Ischemic heart disease

Answer 1

Includes stable angina (pain <10mins), Ac MI/ACS (pain >10mins)

Tightness, pressure, like someone is sitting on the chest
Radiating to arm, neck, back

Infero-posterior part involved - nausea, vomiting

Question 2

What kind of chest pain do you get in Pericarditis

Answer 2

Sharp, Stabbing pain
Relieved on bending down
Worse on lying down
Preceding viral illness

ECG - wide spread ST elevation

Question 3

DD of chest pain with nitroglycerine

Answer 3

Vasodilator
If pain gets better:
1. Cardiac condition
2. Oesophageal spasm

If pain gets worse
1. GERD pain

Question 4

Difference of >20 mm/Hg systolic from left arm to right suggests?

Answer 4

Aortic dissection and is present in ~70% of case

Retrosternal chest pain

Question 5

Initial inv for chest pain

Answer 5

●ECG
●Cardiac troponins (T,I,C) 4-6hrs after onset,+ for 1-2 wk
I - ↑ only in cardiac conditions
T - along with cardiac,↑ also in polymyositis, dermatomyositis, renal disease

●CK-MB in MI 4-6 hrs after onset, + for 2-3 days
●CXR - resp causes

Question 6

Epidemiology of aortic dissection

Answer 6

M>F
R/F:
1. HTN
2. Marfans
3. Turners
4. Ehlers-danos
5. Atherosclerosis
6. Aortic aneurysm
7. Syphilis
8. GCA, Takayasu arteritis

Question 7

Aortic dissection pain, inv

Answer 7

Tear in tunica intima … separation of layers
Sharp, tearing, severe
Radiating to back, abdomen, flank, legs
Difference of systolic BP >20 from one arm to the other
Weak pulse
CXR - WIDENING OF MEDIASTENUM, tracheal deviation to right
CT, MRI
Best - TOE (trans-oesophageal echocardiogram)

Question 8

Types and Mx Aortic dissection

Answer 8

Type A - Proximal to subclavian artery (worse)
Mx - emergency Sx

Type B - Distal to subclavian artery
Mx- Maintain BP IV labetolol .. still high … IV NTG

Question 9

Pulm embolism pain

Answer 9

Sudden onset pain, SOB
Tachycardia, tachypnoea
DVT