Chest Pain Flashcards
Which drug class decreases myocardial oxygen demand?
B-blockers ;by reducing exercise induced HR
Calcium channel blockers; by reducing myocardial work ?? TPR ??
Which drug class decreases coronary blood flow?
reduces preload by causing pooling in peripheral veins reducing myocardial oxygen demand
Nitrates
What is coronary thrombosis?
when a plaque in a coronary artery ruptures
Classify and differentiate the causes of chest pain
- Causes associated with coronary heart disease;
- Angina - due to myocardial ischaemia - Not aassociated with CHD;
- Aortic stenosis
- Hypertrophic obstructive cardiomyopathy
What are the 4 types of angina?
- Stable - worse with exertion
- Unstable - increasing frequency and severity of angina (plaque going from stable to unstable)
- Variant (Prinzmetal) - no cause, spontaneous (st elevation). due to intense coronary spasm @ site of atherosclerotic plaque. pain typical at night.
- Syndrome X - myocardial ischaemia thus ST depression on ecg. No atherosclerosis. Common in Perimenopausal or post menopausal
What is the triad of findings in syndrome X?
Chest pain
Positive exercise test - found st depression
Angiogram of coronary arteries is clear
How long to do ECG for in Prinzmetal angina?
24hours - because they may have spasm at night.
ST elevatoin drops back to normal when spasms cease
What is the key to diagnosis of variant angina?
History - pain when they go to bed
What is decubitus angina?
Angina on lying down. also due to severe coronary artery stenosis; atherosclerosis
What is decubitus angina?
Angina on lying down. also due to severe coronary artery stenosis; atherosclerosis
What type of history is not typical of CHD but rather of other types of chest pain?
Atypical chest pain
left sided
sharp
not relieved by GTN
What is a typical CHD patient?
Middle age man obese diabetes hypertension smoker
males more at risk than female!
What are the characteristics of angina as opposed to other causes of chest pain?
Site - angina is central
Onset - cardiac chest pain is gradual. sudden pain points to musculoskeletal issues (i.e. worse when moving)
Character - dull ache (like a squeezing) as opposed to sharp
Treatment - GTN
Relieving factors - rest
When GTN relieves chest pain, what does this point to?
angina
oesophogeal spasms
Crushing chest pain points to?
MI
What are the characteristics of MI?
3 S’s;
Sudden
Severe crushing chest pain
Sweating
What are the characteristics of Aortic dissection?
Tearing abdominal/back pain
higher risk group; elderly
What are the characteristics of pericarditis?
sharp, sudden chest pain
made worse by deep breaths and posture
risks; preceded by viral infection, usually younger people
relieving factors; sitting forward
Important questions to ask in hx for all diseases but especially cardiac issues (even if you yourself cant do anything about it)?
Previous treatment - can then tell you, i had i.e. stent put in for past MI
How symptoms affecting daily life
Social history - where do you live, what floor? how do you get up to that floor is there a lift?
what 50% of MI’s are followed by what?
angina
What tests would you order for someone with chest pain history?
ECG (resting) Angiogram Bloods - Lipid profile Exercise stress test Blood pressure
What ECG signs point to previous MI?
deep Q wave - lead 3
if q wave is present then an inverted t wave supports this more
What is the Bruce protocol?
The Bruce Protocol is a exercise test where the subject works to complete exhaustion as the treadmill speed and incline is increased. The length of time on the treadmill is the test score.
How does MI prognosis relate to the BRUCE protocol?
If the patient last longer than 10 minutes prognosis is good (2% chance of mortality)
If not prognosis is bad (9% chance of mortality)
