Chest Pain Flashcards
What investigations should be onsidered for chest pain
ECG - ischaemia/infarction
Blood tests eg for troponin - may suggest hearts problem or smth else causing chest pain
Chest x rays
What are some cardiac causesof chest pain
Cardiac/vascular
• myocardial infarction - central dull pain
• Myocardial ischaemia (angina) - central dull pain
◦ These 2 may radiate to shoulder neck and jaw
• Pericarditis - pericardial sac attached to diaphragm.- pain when breathing in - causes further irritation
What are vascular causes of chest pain
Vascular
• Aortic dissection (walls tart to split and tear - end point could be rupture) - sharp and sudden tearing pain at the back, battens May collapse
• PE - DVT travel up - lodges in vessel - very acute onset chest pain - lung tissue distal to blockage becomes ischaemic - acute sharp pain - breathless, hypoxic
What are resp causes of chest pain
Respiratory
• pneumonia - chest infection
• Pleurisy - deep breath causes sharp pain since pleura rubbing over each other
• Pneumothorax - stab wound or underlying problems eg cops - units more susceptible to spontaneous pneumothorax - leak of air - collapse of lung - present as breathlessness - do chest x Ray
What are some MSK causes of chest pain
MSK
• Rib fracture - sharp, hurts more when breath in
• Chostochondritis - inflammation of costal carriages - tender when pushing on front of chest
What are GI causes of chest pain
Problems in upper GI could also be described as cheap Bain by patient , eg reflux of peptic ulcer disease
Describe tje difference between cardiac and pleuritic chest pain
Cardiac/ischaemic - visceral pain: dull, poorly localised, worsened with exertion bc related to blood supply as heart has to work harder and heart also needs blood supply
Pleuritic/pleural/pericardial sac - somatic pain: sharp pain, often well localised, worse with inspiration, coughing or positional movement eg easier to sit forward
What is pericarditis
• Inflammation of the pericardium
– More common in men and adults
• Often secondary to a viral illness
• Present with chest pain
– Retrosternal (behind sternum)
– Sharp pain, localised to front of chest
– Aggravated with inspiration, cough, lying flat (pleuritic sounding chest pain)
– Eased with sitting up and leaning forward (positional)
– Pericardial rub may be heard on auscultation
• widespread saddle shaped ST elevation (almost all leads)
What is cardiac ischaemic heart disease and what causes it
• diseas of coronary arteries
• Pain secondary to pathology
involving the heart
– Ischaemic heart disease
• Potentially a life-threatening cause of chest pain
- could lead to necrosis
•caused by atherosclerosis which impedes blood supply - this becomes more o a problem when excersising when heart needs more o2
What are the risk factors for the development of atherosclerosis and hence ischaemic heart disease
Modifiable • Smoking • Hypertension • Dyslipidaemia • Diabetes • Obesity • Sedentary lifestyle
Non- Modifiable
• Advanced age
• Family history (of early IHD)
• Male
What is stable angina and describe teh typical patient history
• Angina is chest pain that occurs when the blood supply to the muscles of the heart is restricted. It usually happens because the arteries supplying the heart become hardened and narrowed.
Heart tissue ischaemia occurs only when metabolic demands of cardiac muscle are greater than what can be delivered via coronary arteries e.g. on exertion
• Dull, central
• Comes on with exception and relieved by rest
• May or may not radiate to shoulder/jaw/arm
• Not typically associated with autonomic features such s sweating and nausea
What is acute coronary syndrome and give examples
Acute myocardial ischaemia caused by atherosclerotic coronary artery disease
– Atheromatous plaques rupture with thrombus formation causing an acute
increased occlusion (in an already partially occluded lumen) leading to
ischaemia…and potentially infarction (myocardial tissue necrosis)
Unstable angina
Myocardial infarction
Non-ST elevation myocardial infarction (NSTEMI)
ST elevation myocardial infarction (STEMI)
How can unstable angina/NSTEMI/stemi be differentiated
Increasing occulusion UA->NSTEMI->STEMI
Heart tissue ischaemia - no cardiac enzyme leak
Heart tissue death (infarction) - cardiac enzyme leak
Blood test can differentiate unstable angina vs MI
ECG differentiates NSTEMI vs STEMi
What are the features of unstable angina
Many similarities to stable angina
EXCEPT
• Pain occurs at rest • Or deteriorating symptom control • Pain may be more intense • Pain may last longer
• Risk of deteriorating further ->
NSTEMI or STEMI
What are the clinical features of MI
- Dull central chest pain
- @ rest
- Severe pain
- Nausea/sweating
- May become breathlessness
