Chest pain

Question 1

List some risk factors for IHD?

Answer 1

Smoking
Family history
Diabetes
Previous MI, stroke
Male
Alcohol
Sedentary lifestyle
Age

Question 2

What is the differential diagnosis of acute onset chest pain?

Answer 2

VITAMIN D

V: angina, MI

I: myocarditis, pleurisy, pneumonia

T: rib fracture, MSK

A:
M:

I: anxiety

N:
D:

Other: GORD, dyspepsia

Question 3

What investigations do you do for a patient presenting with possible IHD?

Answer 3

ECG

Bloods: FBC, U+E, glucose, cardiac enzymes

Question 4

Which cardiac enzymes do you test?

Which is preferred?

Answer 4

Troponin I and T (preferred as highest sensitivities and specificities)

Creatinine kinase

Myoglobin

Natriuretic peptides

Question 5

What is troponin?

When do levels rise and when do they peak?

Answer 5

A protein released from myocytes when they’re irreversibly damaged

Start to rise 3-12hrs after onset of pain
Peak at 24-48hrs

Question 6

What’s the management for a patient having an MI?

Answer 6

ABCDE

MONA
Morphine
Oxygen
Nitrate (GTN)
Aspirin

Clopidogrel

Question 7

What would you see on an ECG in:

• anterior MI
• septal MI
• lateral MI
• inferior MI

Answer 7

Anterior: V1-V6 ST elevation

Septal:

• V1-V4 ST elevation
• disappearance of Q in leads V5, V6

Lateral:

• I, aVL, V5, V6 elevation
• II, III, aVF depression

Inferior:

• II, III, aVF elevation
• I, aVL depression

Question 8

What is thrombolysis?

Answer 8

Giving a clot-busting drug

IV alteplase, streptokinase

These drugs dissolve clots and restore blood flow to myocardium

Also used after ischaemic strokes

Question 9

5 contra-indications of thrombolysis?

Answer 9

Recent surgery
Recent trauma
Recent head injury
On anti-coagulants

Presents over 4.5 hours after onset of pain