Chest Pain Flashcards
What is the breakdown of Ischaemic Heart disease categories?
Vasospastic = Prinzmetal Angina
All else atherosclerotic
Then stable angine or ACS
ACS broken into unstable angina and STEMI and NSTEMI
RFs for IHD?
HTN Smoking Diabetes FHx PMHx Hyperlipidaemia
Stable angina presentation, Ix and management?
Normal on resting examination
Bloods = lipids, FBC and glucose
ECG
Conservative: weight loss, improved diet and smoking cessation
Medical = drugs:
ACEi, antiplatelete.g. aspirin, statins, anti-anginals e.g. Beta-blocker/CCB
GTN spray
Unstable and NSTEMI ECG features?
Normal, inverted T waves or ST depression
NSTEMI has elevated tropomin
ACS signs and symptoms?
Acute central chest pain (grip[png or heavy) +/- radiation to neck,arm,jaw Sweating Pallor \+/- SOB CAN BE SILENT IN OLD or DM
ACS Ix?
ECG and troponins
Coronary anatomy and ECG leadfs?
Anterior/septal leads V1-V4 = LAD
Lateral leads I,aVL V5V6 = LCx or diagonal of LAD
Inferior leads 2,3,aVF = RCA and or LCx
Anterolateral MI V1-V6 - LCA
Posterior MI ST depression V1-V4 = posterior descending
ECG changes in STEMI?
Hyperacute T waves
ST elevation and new LBBB
Old infarct ECG feature?
Pathological Q waves
STEMI management?
<12hrs and PCI in <2 hours = PCI
<12hours and PCI not <2 hours = thrombolysis
>12hours simnce onset = Angio and then possible PCI
Management:
Immediate = morphine, oxygen, nitrates, aspiring and clopidogrel
Long = Betablocker,ACEi and statin, heparin
NSTEMI management?
Same as STEMI but LMWH
Determine risk via GRACE score: low = angiography
Moderate high = angiography with possible PCI
STEMI Complications?
DARTH VADER Death Arrhythmia Rupture Tamponade HF
Valve disease Aneurysm Dresslers syndrome Embolism Reinfarction
Causes of pericarditis?
ABCDIVM
Idiopathic Viral e.g. Coxsacki, mumps, ebv Bacterial e.g. pneumococcus, staph, strep Connective tissue e.g. sarcoidosis Autoimmune e.g. SLE, RA Dressler syndrome (2-10 week post MI Malignancy
RFs for pericarditis?
Male, 20-50, transmural MI, cardiac surgery, neoplasm and uraemia or dialysis
Pericarditis signs and symptoms?
SHarp, stabbing pleuritic chets pain May be releive leaning forward, May radiate to trapezius ridge Corysal Symptoms if viral pericardial friction RUB Tamponade = becks triangle
What is becks triangle?
Low arterial BP, distended neck veins, muffled heart valves. indicate tamponade and constrictive pericarditis
Pericarditis Ix?
ECG showing widespread saddle shaped ST elevation
Or widespread PR depression
Spodicks sign (downsloping TP segment)
Bloods and CXR for pericardial effusion
Pericarditis management?
NSAID + PPI + Cochicine + exercise restriction if viral
Tamponade or purulent = pericardiocentesis + AB as well as above
Complication of pericarditis?
Pericardial effusion +/- tamponade
Chronic constrictive pericarditis
Categories of syncope?
1) arrhythmia related (due to CO compromise e.g. VT or heart block)
2) Cardiac = structural heart disease most notably LV outflow obstruction (HOCM, sevre AS, PE, aortic dissection)
3) Orthosatic
Reflex (reflex vasodilation/bradycardia due to trigger e.g. vasovagal or carotid sinus syncope)