Chest Pain

Question 1

How to differentiate cardiac from non-cardiac
chest pain?

Answer 1

Location: cardiac pain is typically centrally located in the chest (retrosternal in origin), on
account of the derivation of the nerve supply to the heart and mediastinum.
• Radiation: ischemic pain, especially when severe may radiate to the neck, jaw, and upper
and even lower arms.
• Provocation: anginal pain is precipitated by exertion and is relieved by resting. With
deterioration or unstable angina, it is precipitated by minimal exertion or even at rest.
• Character: dull, constricting or heavy. It may be appreciated as discomfort. Patient often
use characteristic hand gestures (open hand or clenched fist) when describing ischemic pain.

Pattern of onset: aortic dissection is very sudden (seconds). Myocardial mar pain is
acute (taking several minutes or even longer).
• Course: Angina builds up gradually in proportion to the intensity of exertion.
• Associated features: the severe pain of myocardial infarction or aortic dissection is
accompanied by:
➢ Autonomic disturbance including sweating, nausea and vomiting.
➢ Breathlessness.
➢ Cough is associated with pulmonary edema.

Question 2

Diference in onset between aortic dissection , angina

Answer 2

aortic dissection is very sudden (seconds). Myocardial mar pain is
acute (taking several minutes or even longer).

Question 3

is the most common cause of death worldwide.

Answer 3

Ihd

Question 4

Ihd risk factors

the most powerful independent risk factor for

The most important modifiable risk factor,

Answer 4

Age
Smoking

Question 5

common in patients with early-onset
disease (age <50 in men and <55 in women
Ihd

Answer 5

Positive family history

Question 6

STEMI
Electrolyte distrbance present

Answer 6

Low k
Low magnesium

Question 7

STEMI
Most imp management

Answer 7

Reperfusion therapy without delay: primary PCI (gold standard) or
thrombolysis

Question 8

Management key points: PE

Answer 8

Start LMWH when PE is suspected.
• Start warfarin when PE is confirmed; continue LMWH until INR is
therapeutic (2– 3)

Question 9

What is the key pathogenic factor in IHD?

Answer 9

Atherosclerosis

Question 10

What is the preferred reperfusion modality
in myocardial infarction?

Answer 10

Percutaneous coronary intervention.

Question 11

What is meant by pulmonary embolism?

Answer 11

• Occlusion of one of the pulmonary arteries.

Question 12

What is the most important first line
treatment for pulmonary embolism?

Answer 12

Anticoagulation