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Cardiology > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

Causes of acute chest pain

A 
Myocardial infarction
Pulmonary embolism
Pneumothorax
Other causes of pleuritic pain
Pericarditis
Aortic dissection
Ruptured oesophagus
Oesophagitis
Collapsed vertebrae
Herpes zoster
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2
Q

Causes of chronic or recurrent chest pain

A 
Angina
Nerve root pain
Muscular pain
Oesophageal reflux
Nonspecific pain
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3
Q

Main features of acute chest pain cause by myocardial infarction

A

Central
Radiates to neck, jaw, teeth, arms or back
Severe
Associated with nausea, vomiting and sweating

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4
Q

Main features of acute pain caused by a pulmonary embolism

A

Causes pain similar to MI if the embolus is central
Causes pleuritic pain if the embolus is peripheral
Associated with breathlessness or haemoptysis
Can cause haemodynamic collapse

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5
Q

Features of acute chest pain caused by lung disease (infection or pneumothorax)

A

Worse on breathing

Associated with cough

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6
Q

How to recognise pericardial pain?

A

Can mimic cardiac ischaemia and pleuritic pain

Relived by sitting up and leaning foreword

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7
Q

How to recognise an aortic dissection

A

Causes a ‘tearing’ pain (rather than crushing) and usually radiates to the back

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8
Q

How to determine if acute chest pain is oesophageal rupture

A

Follows vomiting

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9
Q

What is spinal pain affected by?

A

Posture

Associated nerve root pain follows nerve root distribution

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10
Q

What does examination finding of Lv failure suggest?

A

Myocardial infarction

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11
Q

What does a raised JVP suggest?

A

Myocardial infarction

Pulmonary embolus

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12
Q

What does a pleural friction rub suggest

A

Pulmonary embolism

Infection

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13
Q

What does a pericardial friction rub suggest?

A

Pericarditis (viral or secondary to MI)

Aortic dissection

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14
Q

What does aortic regurgitation suggest?

A

Aortic dissection

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15
Q

What does unequal pulses or unequal BP suggest?

A

Aortic dissection

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16
Q

What does bing tenderness suggest?

A

Musculoskeletal pain

17
Q

What are the main signs to look out for in diagnosing angina?

A

Predictable
Usually occurs after a constant amount of exercise
Worse cod or windy weather
Induced by emotional stress
Induced by sexual intercourse
Relived by rest, and rapidly by a short acting nitrate (GTN spray)

18
Q

What are the main physical signs of angina?

A

Evidence of risk factors - high BP, cholesterol, deposits, signs of smoking
Any signs of cardiac disease - aortic stenosis, an enlarged heart, signs of heart failure
Anaemia
Signs of peripheral vascular disease - suggesting coronary disease is also present

19
Q

What is needed before diagnosing an MI

A

Abnormal ECG
An ECG will demonstrate ischaemia in patients with angina provided that the patient is having pain at the time of the ECG

20
Q

What does the term acute coronary syndrome include? Elevation

A

MI with St segment elevation on ECG
Mi with only I ware inversion or St segment depression (shown by a troponin rise)
Chest pain with ischaemia ST segment depression but no troop in rise (unstable angina)
Sudden death due to coronary disease

21
Q

What are the sequence of features characteristic of a ‘full-thickness’ or ST segment elevation MI?

A 
Normal ECG
ST segment elevation
Development of Q waves
ST segment returns to the baseline
T Waves become inverted
22
Q

Features of an ECG of a patient with an acute inferior infarction upon admission to hospital

A

Sinus rhythm
Normal axis
Small Q waves in leads II, III and VF
Raised ST segments in leads II, III and VF
Depressed ST segments in leads I, VL, V2, V3
Inverted T waves in leads I, VL, V3

23
Q

Features of an ECG of a patient with an acute inferior infarction 3hours after admission

A

Sinus rhythm with ventricular extrasystoles
Normal axis
Deeper Q waves in leads II, III and VF
ST segments returning to normal, but still elevated in inferior leads
Less ST segment depression in leads I, VL, V3

24
Q

Features of an ECG of a patient with an acute inferior infarction 2 days after admission to hospital

A 
Sinus rhythm
Normal axis
Q waves in leads II, III, VF
ST segments nearly back to normal
T wave inversion in leads II, III, VF
Lateral ischaemia has cleared (shown by ST segments in lateral leads)

Cardiology (6 decks)

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