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Year 3 ELs > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

Which drug class decreases myocardial oxygen demand?

A

B-blockers ;by reducing exercise induced HR

Calcium channel blockers; by reducing myocardial work ?? TPR ??

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2
Q

Which drug class decreases coronary blood flow?

reduces preload by causing pooling in peripheral veins reducing myocardial oxygen demand

A

Nitrates

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3
Q

What is coronary thrombosis?

A

when a plaque in a coronary artery ruptures

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4
Q

Classify and differentiate the causes of chest pain

A
  1. Causes associated with coronary heart disease;
    - Angina - due to myocardial ischaemia
  2. Not aassociated with CHD;
    - Aortic stenosis
    - Hypertrophic obstructive cardiomyopathy
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5
Q

What are the 4 types of angina?

A
  1. Stable - worse with exertion
  2. Unstable - increasing frequency and severity of angina (plaque going from stable to unstable)
  3. Variant (Prinzmetal) - no cause, spontaneous (st elevation). due to intense coronary spasm @ site of atherosclerotic plaque. pain typical at night.
  4. Syndrome X - myocardial ischaemia thus ST depression on ecg. No atherosclerosis. Common in Perimenopausal or post menopausal
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6
Q

What is the triad of findings in syndrome X?

A

Chest pain
Positive exercise test - found st depression
Angiogram of coronary arteries is clear

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7
Q

How long to do ECG for in Prinzmetal angina?

A

24hours - because they may have spasm at night.

ST elevatoin drops back to normal when spasms cease

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8
Q

What is the key to diagnosis of variant angina?

A

History - pain when they go to bed

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9
Q

What is decubitus angina?

A

Angina on lying down. also due to severe coronary artery stenosis; atherosclerosis

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10
Q

What is decubitus angina?

A

Angina on lying down. also due to severe coronary artery stenosis; atherosclerosis

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11
Q

What type of history is not typical of CHD but rather of other types of chest pain?

A

Atypical chest pain
left sided
sharp
not relieved by GTN

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12
Q

What is a typical CHD patient?

A 
Middle age man
obese
diabetes
hypertension
smoker

males more at risk than female!

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13
Q

What are the characteristics of angina as opposed to other causes of chest pain?

A

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

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14
Q

When GTN relieves chest pain, what does this point to?

A

angina

oesophogeal spasms

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15
Q

Crushing chest pain points to?

A

MI

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16
Q

What are the characteristics of MI?

A

3 S’s;

Sudden
Severe crushing chest pain
Sweating

17
Q

What are the characteristics of Aortic dissection?

A

Tearing abdominal/back pain

higher risk group; elderly

18
Q

What are the characteristics of pericarditis?

A

sharp, sudden chest pain

made worse by deep breaths and posture
risks; preceded by viral infection, usually younger people
relieving factors; sitting forward

19
Q

Important questions to ask in hx for all diseases but especially cardiac issues (even if you yourself cant do anything about it)?

A

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?

20
Q

what 50% of MI’s are followed by what?

A

angina

21
Q

What tests would you order for someone with chest pain history?

A 
ECG (resting)
Angiogram
Bloods - Lipid profile
Exercise stress test
Blood pressure
22
Q

What ECG signs point to previous MI?

A

deep Q wave - lead 3

if q wave is present then an inverted t wave supports this more

23
Q

What is the Bruce protocol?

A

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.

24
Q

How does MI prognosis relate to the BRUCE protocol?

A

If the patient last longer than 10 minutes prognosis is good (2% chance of mortality)

If not prognosis is bad (9% chance of mortality)

25
Q

When patients are given oestrogen, what length of st segment depression points to myocardial ischaemia + CHD?

A

depression greater than 1mm.

remember syndrome x patients dont have CHD.

26
Q

How is coronary arterography useful in angina?

A

It is used to risk stratify those with angina to see how extensive the disease is.

it is when a catherter/tube are inserted into the coronary artery

27
Q

How do you manage chest pain, if the cause is CHD related?

A

All of the following together:

  1. Risk factor management + education;
    exercise and comordity management (i.e. diabetes or hypercholesterolaemia).
  2. Anti-platelets (aspirin 75 mg)
  3. Statin; atrovastatin
    (consider ezetimibe then pcsk9i if ineffective)

If have angina add:

  1. Anti-anginal therapies; sublingual GTN
  2. BB +- CCB (nifedipine) +- ISMN
  3. Revascularisation therapy (CABG or PCI - percutaneous coronary intervention)
28
Q

Name some anti-anginal drugs?

A
  1. Beta-blockers;
    Atenolol (25mg), bisoprolol (2.5mg)
  2. Calcium antagonists;
    - Diltiazem, verapamil
    - Dihydropyridines - ‘dipines’ - amlodipine.
  3. Nitrates;
    GTN, long acting nitrates (ISMN, ISDN)
  4. Nicorandil

(note aspirin is NOT part!)

29
Q

Why dont we use DHPs alone for angina?

A

Cuases reflex tachycardia

so not monotherapy! combined with beta blockers

30
Q

go read missing slides too long ffs

A

okay

31
Q

Symptoms of aortic stenosis?

A

breathless on exertion
chest pain
syncope

32
Q

In stable angina, which therapy improves long term mortality?

A

Atorvastatin

Year 3 ELs (10 decks)

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