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Y3 MedEd > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

Define stable angina

A

Chest pain resulting from myocardial ischaemia that is precipitated by exertion and relieved by rest.

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2
Q

Most common cause of stable angina

A

Atherosclerotic disease

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3
Q

Define decubitus angina

A

symptoms occur when lying down

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4
Q

Define prinzmetal angina

A

symptoms of angina caused by coronary vasospasm

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5
Q

Define coronary syndrome X

A

symptoms of angina but with normal exercise tolerance and normal coronary angiograms

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6
Q

Medical Mx of stable angina (3 therapeutic targets)

A
  • Anti-anginals (BB/CCB)
  • Symptomatic (GTN spray)
  • Risk factor reduction (aspirin, statins, ACEi)
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7
Q

Define ACS and the three types

A

A constellation of symptoms caused by sudden reduced blood flow to the heart muscle.
Unstable angina
STEMI
NSTEMI

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8
Q

Which populations are prone to silent infarcts

A

Elderly and diabetics

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9
Q

Define unstable angina

A

Chest
pain at rest due to ischaemia without
cardiac injury

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10
Q

Which artery is infracted in an inferior MI

A

right coronary artery

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11
Q

Which artery is infracted in an anterior MI

A

left anterior descending

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12
Q

Which artery is infracted in a lateral MI

A

left circumflex

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13
Q

What ECG changes suggest a posterior MI

A

Tall R and T waves in V1-2 and ST depression in V1-3

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14
Q

General ACS Mx (8)

A 
Morphine
Oxygen
Nitrates
Antiplatelets (aspirin and clopidogrel)
Beta-blockers
ACEi
Statins
Heparin
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15
Q

What is the aim of STEMI treatment

A

Coronary reperfusion either by PCI or fibrinolysis

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16
Q

Mx of STEMI

A

Patient presenting < 12 hours from onset of symptoms
• Send to cathlab for PCI if it can happen within 120 mins of the time that fibrinolysis could have been administered
Patient presenting > 12 hours from onset of symptoms
• Coronary angiography followed by PCI if indicated

17
Q

Immediate Mx of NSTEMI/UAP

A

• Aspirin + other antiplatelet (e.g. clopidogrel, ticagrelor)
• Fondaparinux – if low bleeding risk unless coronary angiography planned within
24 hrs of admission
• Unfractionated heparin – if coronary angiography is planned

18
Q

After immediate Mx of NSTEMI

A
  • HIGH risk
  • GlpIIb/IIIa inhibitor (e.g. tirofiban)
  • Coronary angiography (within 72 hours)
  • LOW risk
  • Conservative management (control risk factors)
19
Q

Complications of ACS

A

Death, Arrhythmia, Rupture, Tamponade, Heart failure

Valve disease, Aneurysm, Dressler’s syndrome, Embolism, Reinfarctio

20
Q

Which virus most commonly causes pericarditis

A

Coxsackie B

21
Q

Causes of AF (6)

A 
Absolutely loads but the main ones are:
• Pneumonia
• PE
• Hyperthyroidism
• Ischaemic heart disease
• Alcohol
• Pericarditis
22
Q

Mx of AF

A 
Treat the cause
  Rhythm Control
• < 48 hrs since onset of AF
• DC cardioversion
• OR chemical cardioversion
(flecainide or amiodarone)
• NOTE: flecainide is contraindicated if
there is a history of IHD
• > 48 hrs since onset of AF 🡪
anticoagulate for 3-4 weeks before attempting cardioversion

Rate Control
• Verapamil
• Beta-blockers • Digoxin

23
Q

Rate control drugs (3)

A
  • Verapamil
  • Beta-blockers
  • Digoxin
24
Q

Is adenosine effective in AF

A

NO

25
Q

Is adenosine effective in atrial flutter

A

NO

26
Q

Which drugs are used in chemical cardioversion

A

flecainide or amiodarone

27
Q

What class of drug is verapamil

A

Non-dihydropyridine CCB

28
Q

What is CHADSVASC score used to calculate

A

Risk of having a stroke in the next ten years

29
Q

What happens in AVNRT

A

A local circuit forms around the AV node

30
Q

What happens in AVRT

A

• A re-entry circuit forms between the atria and ventricles due to the presence of an accessory pathway

31
Q

What is seen in an ECG of an SVT

A
  • Regular
  • Narrow complex tachycardia
  • Absent p waves
32
Q

What is seen on the ECG after termination of SVT (AVNRT AVRT)

A

• AVNRT = normal
• AVRT = ’Delta wave’ (slurred
upstroke on QRS complex)

33
Q

4 steps in SVT Mx

A

STEP 1: is the patient haemodynamically stable?
• NO 🡪 Synchronised DC cardioversion
• YES 🡪 STEP 2

STEP 2: Vagal Manoeuvres – did it work?
YES 🡪 Good Job
NO 🡪 STEP 3

STEP 3a: IV Adenosine 6 mg – did it work?
• YES 🡪 Good Job
• NO 🡪 Step 3b, if that fails, Step 3c, then,
Step 4
• STEP 3b: IV Adenosine 12 mg
• STEP 3c: IV Adenosine 12 mg (again)

STEP 4: Choose from:
• IV β-blocker (e.g. metoprolol)
• IV amiodarone
• IV digoxin
• Synchronised DC cardioversion
34
Q

Which patients are adenosine contraindicated in and what should we use instead when managing SVT

A

E.g. asthma, we should verapamil instead

35
Q

4 signs Of HOCM

A 
• Jerky carotid pulse
• Double apex beat
• Ejection systolic
murmur/crescendo-decresendo murmur
• Family history of
sudden death at a relatively young age (< 65 yrs)

Y3 MedEd (34 decks)

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