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CVS > Chest Pain > Flashcards

Chest Pain Flashcards

0
Q

Where do you feel pain for lungs and pleura?

A

Lateral chest which increases on inspiration

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1
Q

What is affected if the chest pain is in the centre?

A

Heart and great vessels

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2
Q

What can cause pain in the lung and pleura?

A

Pneumonia
Pneumothorax
Pulmonary embolism

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3
Q

What can cause GI pain?

A

Gastro-oesophageal reflux
GB disease
Peptic ulcer

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4
Q

What can cause pain in heart and great vessels?

A

Ischaemic heart disease
Pericarditis
Aortic dissection

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5
Q

When does myocardial ischaemia occur?

A

When the supply of blood cannot reach the demand of the muscles

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6
Q

What does myocardial oxygen supply depend on?

A

Coronary blood flow
-perfusion diastolic pressure and coronary artery resistance

Oxygen carrying capacity of the blood

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7
Q

What does myocardial oxygen demand depend on?

A 
Heart rate
Contractility
Wall tension
-preload
-afterload
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8
Q

When does coronary flow occur?

A

During diastole

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9
Q

In which direction is coronary flow? What does this mean?

A

From the epicardium to endocardium. Sub endocardial muscles is the most vulnerable to ischaemia.

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10
Q

What can decrease myocardial oxygen supply?

A

Severe anaemia

Severe hypotension

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11
Q

What can increase myocardial oxygen demand?

A

Tachycardias
Thyrotoxicosis
Aortic stenosis

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12
Q

Non-modifiable risk factors for coronary artery disease?

A

Increased age
Male gender - females catch up after menopause
Family history

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13
Q

Important modifiable risk factors for coronary artery disease?

A

Hyperlipidaemia
Smoking
Hypertension
Diabetes mellitus

Lack of exercise
Obesity
Stress

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14
Q

Structure of a stable plaque?

A

Small necrotic core

Thick fibrous cap which is less likely to fissure or rupture

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15
Q

Structure of vulnerable plaque?

A

Large necrotic core

Thin fibrous cap which is more likely to fissure or rupture

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16
Q

How can an unstable plaque lead to thrombus formation?

A

Fibrous cal can erode or fissure
Exposes blood to thrombogenic material in the necrotic core
Platelet clot followed by fibrin thrombus

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17
Q

What effects does stable plaque have?

A

Moderate reduction in blood flow
Transient ischaemia during periods of increased oxygen demand
May progress gradually over time to severe fixed narrowing causing ischaemia with less demand

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18
Q

Describe the pain in stable angina

A

Mild to moderate central crushing pain with typical radiation to left/right/both arms or shoulders, neck, jaw, back, epigastrium

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19
Q

What can cheat pain in stable angina be brought on by?

A

Exertion

Emotional stress

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20
Q

What can stable angina pain be relieved by?

A

Rest or nitrates

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21
Q

What signs and symptoms can people who have stable angina present with?

A

Signs related to risk factors such as raised BP, corneal arcus, absent pulses, LV dysfunction

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22
Q

How is the diagnosis of stable angina confirmed?

A

Exercise stress rest.
Graded exercise in a treadmill until target heart rate is reached or chest pain occurs or ECG changes or there are other problems such as arrhythmias or drop in BP

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23
Q

What does stable angina show up as on an ECG during exertion?

A

ST segment depression

With rest ST segment goes back to baseline

24
Q

What is the aim of treatment in stable angina?

A

To reduce myocardial oxygen demand by

  • reducing preload and afterload
  • reducing heart rate
  • reducing myocardial contractility

Increase bloodflow
Prevent progression of atheroma, stabilise plaques and prevent thrombosis

25
Q

What do calcium blockers do?

A

Reduce afterload because they cause peripheral vasodilatation

26
Q

What do nitrates do?

A

Reduce preload because the cause venodilatation

27
Q

Effects of beta blockers?

A

Reduce heart rate and contractility

28
Q

Effects of aspirin?

A

Reduced platelet aggregation therefore reduced thrombus formation if plaques are disrupted.

29
Q

What do statins do?

A

Lower LDL cholesterol ➡️ reduces progression of atherosclerosis ➡️ increases plaque stability

30
Q

Which vessels can be used for a coronary bypass?

A

Internal mammary artery
Radial artery
Saphenous vein

31
Q

Features of a STEMI?

A

Normally total occlusion of an artery
Injury extends to sub-epicardial area which is manifested as an ST elevation in leads facing the injured area
Infarct is full thickness of myocardium

32
Q

What is an MI?

A

Complete occlusion of a coronary vessel leading to an infarct of the myocardium it supplies

33
Q

Features of an NSTEMI?

A

No ST elevation

Infarct is not full thick was of myocardium

34
Q

How are acute episodes of angina treated?

A

Sub-lingual nitrate spray

35
Q

What drugs are used to prevent episodes of angina?

A

β-blockers
Calcium channel blockers
Oral nitrates

36
Q

What drugs are used to prevent cardiac events?

A

Aspirin
Statins
ACE inhibitors

37
Q

What is unstable angina classified as?

A

Ischaemic chest pain that occurs at rest or with minimal exertion, described as severe pain and occurring with a crescendo pattern.

38
Q

What is acute coronary syndrome?

A

A group of symptoms that attribute to the obstruction of the coronary arteries.

39
Q

What is coronary artery syndrome a result of?

A

Unstable angina
NSTEMI
STEMI

40
Q

Do you get occlusion by a thrombus in unstable angina, NSTEMI or STEMI?

A

Unstable angina - partial
NSTEMI - partial
STEMI - total

41
Q

Do you get myocardial necrosis in unstable angina, NSTEMI or STEMI?

A

Unstable angina - none
NSTEMI - some
STEMI - large myocardial infarct

42
Q

ECG in unstable angina?

A

ST segment depression

T wave inversion (sometimes)

43
Q

Biomarkers in blood for unstable angina, NSTEMI or STEMI?

A

No biochemical markers in unstable angina

Troponin in NSTEMI and STEMI

44
Q

How can previous MIs be identified?

A

Persistence of the pathological, deepened Q wave on an ECG

45
Q

Which two proteins are released in myocyte death?

A

Troponin I

Troponin T

46
Q

When does troponin begin to rise and peak?

A

3-4 hours
18-36 hours
After the first onset of pain

47
Q

When do creatine kinase levels rise and peak?

A

3-8 hours

24 hours

48
Q

How long after pain in an MI does it take for troponin and CK to return to normal levels?

A

Troponin - 10-14 days

CK - 48-72 hours

49
Q

Goal of treatment in unstable angina?

A

Prevent it from progressing to MI and limiting muscle loss in MI

50
Q

Goals of treating an MI?

A

Prevent progression of the thrombosis
Restore perfusion of partially occluded vessels
Pain control

51
Q

What drugs are used in anti-thrombotic therapy?

A

Aspirin (antiplatelet)

Heparin (anticoagulant)

52
Q

How is perfusion restored in a partially occluded vessel?

A

Angioplasty (PCI)

Coronary bypass graft

53
Q

What do you find on examination of someone who has had an MI?

A 
Patient is Angus and distressed
Sweaty, sold, clammy skin
Pale
Tachycardia/arrhythmias
Low blood pressure
Signs of heart failure
-S3/S4
-crackling in lungs
54
Q

How to treat a STEMI?

A

Try to do an emergency PCI within 90-120 mins

Fibrinolytic therapy

55
Q

How to treat an NSTEMI?

A

Anti thrombotic therapy

Angiography and PCI/CABG

56
Q

How else do you treat an NSTEMI/STEMI?

A 
Analgesics
Oxygen
Antiplatelets - Clopidogrel and aspirin
Anti-ischaemic therapy - nitrates and beta blockers
ACE inhibitors
Statins
57
Q

Complications of an MI?

A

Sudden cardiac death

  • ventricular fibrillarion
  • asystole

First, second or third degree heart block
Ventricular tachycardia
Heart failrue
Cardiogenic shock

58
Q

Why is ST depression only evident during exercise in angina?

A

As the heat rate increases with exercise, diastole is disproportionately shortened and therefore coronary artery filling is compromised while the oxygen demand is increased.

CVS (19 decks)

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