chest pain Flashcards by Maryam Garkuwa

ftx of chostochondritis

self remitting goes away in a few weeks
but NSSAIDS if really bad you can get steroid injections

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chostrochondritis

inflammation of the costal cartialage

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causes of chostrochondritis

trauma
athletes - constantly straining
recent infection - coughing loads
repitive movements like lifting jobs
coughing a lot, like smoker
or an actual infecton

some rheumatoid diseases can affect sometimes like SLE, RA

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symptoms of chosto chondro

inhaling deeply
chest pain - central
coughing, laughing hurts
lying down hurts

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how would you diagnose chostochronditis

clinically

tender on palpation

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somoen comes in with chest pain what ddx do you not want to miss

MI
PE
PNEUMOTHORAZ
AORTIC DISECTION

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signs of arotic dissection

its qtie varied as the aorta is a wide vessel so any organ can be affcected

chest paon
abdo
back pain
tingling and numbness of extremities
cold extremtiies
radio radio delay
7 radio femoral delay

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rf for dissection

ct diseases
hypertension
aneurysm (weakens wall)

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defintive diagnosis aortic dsscetion

CT ANGIOGRAM (looking at the vessels just like in pulmonary embolism )

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how can we categorise the causes for chest pain

CARDIAC
RESP-pe, pneumothoraz
OESAPHAGEAL
CHEST WALL PAIN

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investigations

bloods -anemia can be a cause, pericarditis

ecg

xray - if s.o.b

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HEART SCORE is for what

likelhood of major caridac event

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patient comes in with chest pain what do you want to make sure you do

troponin - NB
ecg - NB!
CXR - depending on history

Check pulses - AD
murmours

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whast the difference in pain between ACS and AS

AD- very sudden tearing reaches maximum immediately
anterior cp- if ascending aorta
back pain - if descending
abdo - if mesenteric
strok symptoms - if brain vessels

ACS- gradually builds up in minutes

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what do we mean by ACS equivalents

not all patients present with the classic chest pain so look out for the hidden signs

unexplained sweating
2 . epigastric, indigestion
shoulder, arm pain

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who are the groups who typically present atypically for ACS

women

elderly

diabetics

so be careful of
nausea /vomiting
s.o.b
dizziness
jaw neck pain

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why do we do repeat ecgs

because for instance the first ecg may be normal but the patient has someting goin on so if you still suspect something dodgey it doesnt hurt to repeatt

allows you to monitor

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what helps with the pain in chest pain and why do we treat the paiin in ACS

nitrates and morphine

pain increases the demand

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examples of antiplatelets

prasigruel
clopidogrel
ticagrelor

what is dual antiplatelet therapy you can consider (nice ) for STEMI

ASPIRIN

PRASUGREL (if not already taking anitocagulants as high bleeding risk )

clopidgrel (if on antiaogulatns already )

out of prasigurel and clopidogrel which has the highest risk

prasugrel which is why you only give in ACS if pt is not already on anitaocgulants

what is fondaparinox

LMWH

is it alone in STemi To give dual antiplatelet theray yfor pci

No you need anticoagulant too as its working on different things,

pci will cause damage to vessels which can activate the cascade so need antithrombin therapy for during the procedure.

when do you give thromobolysis as oppose to pci

when you cant make the time window within 2 hours

which do we prefer pci or thrombolyis and why

pci - less bleedinf risk esp ICH hemorrage mosr succesful at removing the occulusion and preventing reoccurane

CI to thrombolyis whats the biggest thing we are worried about with thrmobolyis

bleeding diatheis activiley bleeding (except menses) Aortic dissection Severe uncontrolled hypertension (>180/110 mmHg). Recent major surgery or trauma (within 3 weeks).had a stroke in past (3 months ago ) nb intracranial hemorrahe

do you do thromobolyis if symprtom onset is >12 h

generally no because the clot has been become more stabilised at this point making it harder to dissolve the clot bleeding risk increases

neumonic for CI for hemolyis absolute

H – Hemorrhagic stroke (ever) or ischemic stroke within 3 months A – Aortic dissection suspected S – Severe hypertension (SBP >180 or DBP >110, uncontrolled) B – Bleeding diathesis (active internal bleeding) L – Low platelets (<100,000) or recent major surgery/trauma (past 3 weeks) E – Eye problems (e.g., recent retinal hemorrhage) E – Emergency CPR >10 min (traumatic) D – Danger of intracranial neoplasm, aneurysm, or AV malformatio

so what if a patient presents more 12 hours after A STEMI but Pci can be delivered within the guidline timeframe

depends on if they have symptoms or not if stilll symptomatic or ecg changes yes if no symptoms then no manage conservatively

doses of antiplatelets you can give bonus in acs

clopidogrel same as aspirin 300 prasurgrel is 60

RF FOR MI

hypertension diabtes hypercholesteremia smoking alochol family histry age

why do we use heart score

likelihood of a major cardiac event happenign Quickly risk-stratifies patients with chest pain in the Emergency Department (ED). Helps decide whether to admit, discharge, or do further testing. Simple, easy to use, and commonly applied in low-to-intermediate-risk patients. 0-3 (Low risk): Discharge, outpatient follow-up. 4-6 (Moderate risk): Consider stress test, further evaluation. 7-10 (High risk): Admit, urgent cardiology evaluation.

common complicatons of on MI

acute MR- pansystolic due to papiallry muslce rupture aneurysm of wall hole in septem - often hear a systolif murmour dresslers heart failure

investigations for suspected PE

1. CXR-rule out pneumo, infection 2.ECG -rule out Mi 3. TROPONIN - eveidence of right strain hearts strain 4. echo -

why order troponin in suspected PE

becayse righ heart strain and if the case then need echo

triad of pe

dyspena - most common chest pain pleuritic hemoptysis

signs you may observe in PE

CRACKLES !! decreased air entry tachy hypo dyspnea slight temp is possible ! rule out infection hypoxia

qhat happens if you do a ct pa and its negative

then consider dvt do ultrasound

if wells >4 what to do

immediate ct pa or if going to be a while start on anticoagulation

if wells is <4

do a d dimer (within 4 hours) or start interim coagulation if postive - do CT PA IF NEGATIVE -

if you cant do a ctpa whats options

v/q scan

WHAT COULD ABG SHOW IN PE

type 1 failure resp alkolosi due to hyperventilation

signs of a massive pE and what to do

persistent hypotension despite giving fluids <90 systolic for more than 15 minutes OR A DROP IN SYSTOLIC BP OF MORE THAN 40 MMHG PE or if in cariac arrest because of theperistant hypotension go straight for alteplase

PESI SCORE VS WELLS

WELLS- DO THEY ACTUALY HAVE A PE PESI - ONCE THEY DO HOW BAD IS IT

DIFFERENECE IN PAIN BETWEEN MI AND PE

MI - SQUEEZING, CRUSHING, LIKE SOMEONE SITTING ON YOUR CHEST, TIGHT - central or to the left PE- sharp , stabbing pain , often localised t one side of the chest , more pleuritic in nature

What is the most common ECG abnormality seen in patients with a pulmonary embolism (PE)?

TACHY maybe s1q3t3