Chest Pain Flashcards
Give some respiratory causes of chest pain
- pneumonia
- pulmonary embolism
Describe chest pain associated with pulmonary embolism
- to the side of the chest
- sharp
- localised
- worse when they breath in or cough
Describe chest pain in pneumonia
- not in the centre of the chest
- temperature, cough and breathlessness
Give a cause of gastrointestinal chest pain
- acid reflux
Describe chest pain from acid reflux
Burning pain running up to the chest or centrally
-worse lying flat or having certain food
Give cardiac causes of chest pain
- ischaemic
- pericarditis
Describe ischaemic chest pain
- dull pain in the retrosternal
- poorly localised
- may radiate pain into the jaw, shoulder and neck
- worse with exertion
Describe pericarditis chest pain
- sharp pain in the retrosternal
- eased when sitting up and leaning forward
- coughing and deep breathing make it worse
Give some musculoskeletal causes of chest pain
- rib fracture
- costochondritis
Describe the pain associated with costochondritis
- sharp pain
- tender to palpate
- worse when coughing or breathing in
What is visceral ischaemic chest pain
Pain originating from the organ or tissue
What is somatic pain
Pain relating to the pleural sac or pericardial sac
Describe visceral pain
- dull, poorly localised
- worse with exertion
Describe somatic pain
- sharp pain, well localised
- worse with inspiration, coughing or changing position
What is pericarditis
Inflammation of the pericardium often secondary to viral infections
Hat may be heard on auscultation in pericarditis
The pericardial rub which is a coarse noise
Describe the ECG of someone with pericarditis
- elevated ST with saddle appearance
True or false - atherosclerosis is a cause of non ischaemic chest pain
False - its a cause of ischaemic cardiac chest pain
What is stable angina
Where heart tissue ischaemia only occurs during exercise as the occlusion of the arteries by the atheroma only compromises the demand of the heart during this increased requirement
What is a typical patient history of stable angina
- chest pain when exercising
- dull, retrosternal pain
- no pain at rest
- radiating pain to neck and shoulder
- GTN spray relieves pain
What are acute coronary syndromes
Problems which cause a sudden reduction in blood flow to the heart
True or false- stable angina is an acute coronary syndrome
False - stable angina does not cause sudden reduction of blood flow
How do atheromas cause acute coronary syndromes
The atherosclerotic plaque ruptures, platelets aggregate and a thrombus forms. This can then completely occlude the lumen.
How much of the lumen is occluded in an STEMI resulting acute coronary syndrome
All of the lumen
In unstable angina how much of the lumen is occluded
- only partially occluded but there’s worsening ischaemia
- means that pain is still there at rest
True or false - there is infarction of tissue in Non-STEMIs
True as there is a very small lumen
When are cardiac enzymes released from muscle cells
During infarction so when the muscle cells are dead
True or false - cardiac enzymes are released during ischaemia
False - only infarction
What are the difference in the the patient history of unstable angina and stable angina
- pain at rest
- pain more intense
- pain lasts longer
- GTN doesn’t work
- risk of deteriorating further to a NTSTEMI or STEMI
Describe the patient history for a myocardial infarction
- dull, retrosternal pain (more severe than angina) for more than 15 mins
- radiates to neck and shoulders
- looks unwell
- increased autonomic output
- GTN spray and resting doesn’t help
True or false - clinical examinations for stable angina and acute coronary syndromes will always be abnormal
False - they are often normal
What diagnostic tests can be done for acute coronary syndrome
- ECG
- blood tests
What are you looking for in blood tests for suspected acute coronary syndromes
Troponin to see if there’s myocyte death
On an ECG what do patterns of infarct look like
- ST elevation
- hyperacute T waves
what may cause an elevated ST wave
- MI
- left bundle branch block
months after a STEMI what will the ECG have
prominent Q wave
what ECG patterns are seen in ischaemia
- ST depression
- T wave flattening
how do you distinguish between a NSTEMI and unstable angina
troponin levels in the blood - troponin is present in NSTEMI
what would you look at in blood tests for stable angina
- FBC = looking for anaemia
- cholesterol
- thyroid function (hypothyroidism can cause anaemia)
how will adenosine be used to look for ischaemia
adenosine causes vasodilation of the coronary arteries allowing you to see a blockage
what medications can be used for stable angina
- aspirin
- beta blockers
- statin
- ACE inhibitors
how does aspirin help in stable angina
anti platelet drug so prevents them sticking together
what treatments are used for stable angina
- CABG
- angioplasty
what is the difference in occlusion of an artery of a STEMI and NSTEMI
STEMI = full occlusion NSTEMI = large occlusion
what is referred pain
where pain is felt away from the site of origin
why does referred pain occur
the afferent signals of pain from the heart go to the brain along the same passageway as the dermatomes T1-T4. the brain then confuses the messages and presumes the pain is in the dermatomes so does this through the efferent signals
what is radiating pain
when the pain starts in one place and moves around
what is a percutaneous coronary intervention
a non-surgical procedure where a balloon catheter is inserted through the femoral or radial artery and is used to inflate the coronary artery. A metal stent is then added
why is an ECG normal for someone with stable angina
at rest there is no significant occlusion to the blood flow so the demands of the heart are met
what are the advantages of a coronary angiogram to a catheter angiogram
quicker, non-invasive and less complications
