Chest Pain Flashcards
Define stable angina
Chest pain resulting from myocardial ischaemia that is precipitated by exertion and relieved by rest.
Most common cause of stable angina
Atherosclerotic disease
Define decubitus angina
symptoms occur when lying down
Define prinzmetal angina
symptoms of angina caused by coronary vasospasm
Define coronary syndrome X
symptoms of angina but with normal exercise tolerance and normal coronary angiograms
Medical Mx of stable angina (3 therapeutic targets)
- Anti-anginals (BB/CCB)
- Symptomatic (GTN spray)
- Risk factor reduction (aspirin, statins, ACEi)
Define ACS and the three types
A constellation of symptoms caused by sudden reduced blood flow to the heart muscle.
Unstable angina
STEMI
NSTEMI
Which populations are prone to silent infarcts
Elderly and diabetics
Define unstable angina
Chest
pain at rest due to ischaemia without
cardiac injury
Which artery is infracted in an inferior MI
right coronary artery
Which artery is infracted in an anterior MI
left anterior descending
Which artery is infracted in a lateral MI
left circumflex
What ECG changes suggest a posterior MI
Tall R and T waves in V1-2 and ST depression in V1-3
General ACS Mx (8)
Morphine Oxygen Nitrates Antiplatelets (aspirin and clopidogrel) Beta-blockers ACEi Statins Heparin
What is the aim of STEMI treatment
Coronary reperfusion either by PCI or fibrinolysis
Mx of STEMI
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
Immediate Mx of NSTEMI/UAP
• 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
After immediate Mx of NSTEMI
- HIGH risk
- GlpIIb/IIIa inhibitor (e.g. tirofiban)
- Coronary angiography (within 72 hours)
- LOW risk
- Conservative management (control risk factors)
Complications of ACS
Death, Arrhythmia, Rupture, Tamponade, Heart failure
Valve disease, Aneurysm, Dressler’s syndrome, Embolism, Reinfarctio
Which virus most commonly causes pericarditis
Coxsackie B
Causes of AF (6)
Absolutely loads but the main ones are: • Pneumonia • PE • Hyperthyroidism • Ischaemic heart disease • Alcohol • Pericarditis
Mx of AF
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
Rate control drugs (3)
- Verapamil
- Beta-blockers
- Digoxin
Is adenosine effective in AF
NO
Is adenosine effective in atrial flutter
NO
Which drugs are used in chemical cardioversion
flecainide or amiodarone
What class of drug is verapamil
Non-dihydropyridine CCB
What is CHADSVASC score used to calculate
Risk of having a stroke in the next ten years
What happens in AVNRT
A local circuit forms around the AV node
What happens in AVRT
• A re-entry circuit forms between the atria and ventricles due to the presence of an accessory pathway
What is seen in an ECG of an SVT
- Regular
- Narrow complex tachycardia
- Absent p waves
What is seen on the ECG after termination of SVT (AVNRT AVRT)
• AVNRT = normal
• AVRT = ’Delta wave’ (slurred
upstroke on QRS complex)
4 steps in SVT Mx
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
Which patients are adenosine contraindicated in and what should we use instead when managing SVT
E.g. asthma, we should verapamil instead
4 signs Of HOCM
• Jerky carotid pulse • Double apex beat • Ejection systolic murmur/crescendo-decresendo murmur • Family history of sudden death at a relatively young age (< 65 yrs)
