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Chest pain TCD Case 1 > Chest pain > Flashcards

Chest pain Flashcards

1
Q

What is CVD (cardiovascular disease)?

A

Generally due to reduced blood flow to the heart, brain or body caused by atheroma to thrombosis. Plaques of fatty atheroma build up in different arteries during adult life.

These can eventually cause narrowing of arteries, or trigger local thrombosis (blood clot) which completely blocks the blood flow

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2
Q

Risk factors for CVD?

A 
Smoking/tobacco use
Poor diet
High blood cholesterol
High BP
Lack of exercise
Obese
Diabetes
Psychosocial stress
Excess alcohol
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3
Q

Types of CVD?

A

Coronary heart disease (CHD), stroke and peripheral arterial disease (PVD)

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4
Q

What is Acute Coronary Syndrome (ACS)?

A

Refers to: unstable angina, NSTEMI and STEMI

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5
Q

CAD (coronary artery disease) presentation?

A 
Silent ischaemia
Stable/unstable angina pectoris
NSTEMI
STEMI
Heart failure
Sudden death
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6
Q

What is the presentation of ACS?

A

Chest pain >20 mins at rest - CENTRAL CRUSHING PAIN
New onset angina and worsening of existing angina
Angina after MI
(Atypical presentations common in >75)

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7
Q

What is the pathophysiology of ACS?

A

Acute thrombosis induced by ruptured atherosclerotic plaque -> vasoconstriction -> critical reduction in coronary blood flow

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8
Q

What does an ECG show in ACS?

A 
Can be normal but does NOT exclude ACS
Abnormal ECG shows:
- ST depression
- Transient ST elevation 
- T wave inversion

(Should be done in ambulance or within 10 mins of arriving at hospital)

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9
Q

What biomarkers are assessed in ACS?

A

Troponin I and T - GOLD standard

  • reflects myocardial cellular damage
  • raised troponin can be due to factors other than heart failure e.g. renal failure, PE, exertion

Creatine kinase is also raised

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10
Q

What types of imaging may be used?

A 
Non-invasive:
- 12 lead ECG
- Echo
- CT coronary angiography 
Invasive - coronary angiography (GOLD standard)
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11
Q

What are the GRACE and CRUSADE scores?

A

They are risk scores:
GRACE - for ischaemic risk
CRUSADE - for bleeding risk

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12
Q

Symptoms of ACS (for NSTEMI and STEMI)?

A

Acute central chest pain, lasting >20min,

Often associated with nausea, sweatiness, dyspnoea, palpitations

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13
Q

What is the immediate management of suspected ACS?

A 
12 lead ECG
Pain relief - morphine
GTN
300mg Aspirin
Give O2
Takes blood (including for troponin)
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14
Q

If ECG shows STEMI/new LBBB, how do you manage?

A

Assess for eligibility for repercussion therapy:

  • PCI/stenting (if possible under 2 hours of symptoms onset)
  • Fibrinolysis (if great than 2 hours of symptoms onset)

CABG (coronary artery bypass grating) - also a possibility

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15
Q

If ECG shows NSTEMI, what does this look like and how to manage?

A

ECG shows:

  • ST depression
  • T wave inversion

Also will have high troponin

Give 300mg aspirin, fondaparinux (factor Xa inhibitor)
Clopidogrel for longer term

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16
Q

What is the long term management of ACS?

A

Aspirin (75mg) for life - for secondary prevention of CVD
- with clopidogrel or ticagrelor for first 12 months (dual anti-platelet therapy)
Statins (atorvastatin 80mg) - aiming for LDL <1.8mmol/l
Beta-blocker + ACE-inhibitor (to all)

17
Q

What is angina?

A

Discomfort in chest and/or adjacent areas (jaw, shoulder, back, arm) due to NARROWING of coronary artery (causing myocardial ischaemia)

18
Q

What are the feature of angina?

A
  • Constricting/heavy discomfort in front of chest, neck, shoulder, jaws or arms
  • Symptoms brought on by exertion
  • Symptoms relieved within 5 min by rest or GTN
19
Q

Typical angina vs atypical ?

A

All 3 feature of angina present = typical

Only 2 features present = atypical

20
Q

Drug treatment of stable angina?

A

1st line: Beta-blocker or CCB
2nd line: BOTH
3rd line: long-acting nitrate, ivabradine, nicorandil or ranolazine

GTN spray
75mg aspirin for secondary prevention of CVD

21
Q

What complications can occur post MI?

A

Decreased contractility
- Hypotension -> decreased vessel perfusion -> ischaemia
- Potential embolism
Electrical instability
- Arrhythmias
Tissue necrosis
- Inflammation of pericardium -> pericarditis
- Loss of papillary muscles -> regurgitation
- Ventricular septal defect

22
Q

What are the cardiovascular causes of chest pain?

A

Myocardial ischaemia
- CAD

Cardiovascular non-ischaemic

  • Aortic dissection (injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart)
  • Pericarditis (inflammation of heart wall)
23
Q

What are the upper GI causes of chest pain?

non-cardiovascular

A

GORD
Gallstones
Peptic ulcer
Pancreatitis

24
Q

What are the respiratory causes of chest pain?

non-cardiovascular

A

PE
Pneumothorax
Pleurisy
Pneumonia

25
Q

What are the musculoskeletal causes of chest pain?

non-cardiovascular

A 
Costocondritis (pain at rib junction connecting rib to sternum)
Herpes zoster (shingles)

Chest pain TCD Case 1 (2 decks)

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