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Year 3 Conditions > Chest pain > Flashcards

Chest pain Flashcards

1
Q

What can cause muscoskeletal chest pain

A

Sprained muscle from coughing
Bornholms disease
Idiopathic costochondritis
VZ infection

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2
Q

What is bornholms disease

A

Cocksackie B infection leading to muscoskeletal pain

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3
Q

What is Tietzes syndrome

A

Idiopathic costochondritis

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4
Q

How does Varicella zosta infection lead to chest pain

A

Causes neuropathic pain restricted to a dermatome

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5
Q

What gastro conditions can cause chest pain

A 
Cholecystitis
Peptic ulcer disease
Pancreatitis
Oesophagitis
GORD
Oesophageal spasm
Boerhaves perforation
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6
Q

Cardio conditions causing chest pain

A 
ACS
Pericarditis
Aortic dissection
Myocarditis
Aortic stenosis
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7
Q

What can cause a coronary vasospasm

A

Cocaine

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8
Q

What can lead to an MI two pathophysiologies

A

Vasospasm

Blockage in vessel

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9
Q

Examination findings MI

A 
Xanthelasma
Xanthomata- elbows back of hands
Corneal arcus
Cyanosis
Weak pulses
Bruits
Legs look for ulcers hair loss
Signs of arrythmia
Signs of arrythmia or HB as can occur post MI
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10
Q

How can brady or tachy arrythmias lead to MI

A

Reduced CO

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11
Q

What can be lung finding of aortic dissection

A

Pleural effusion

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12
Q

Risk factors for aortic dissection

A

HTN
Atherosclerosis
IHD history
Recent aortic valve replacement

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13
Q

How is pneumothorax different from collapse

A

In collapse bronchus is blocked so air slowly gets absorbed into blood

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14
Q

How can pneumothorax just present

A

SOB

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15
Q

Do PE patients tend to show signs of hypoxia

A

Not normally only if massive

But can often show signs of desturation when walking

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16
Q

How does a boerhaves perforation present

A

Chest pain
Haematemesis
SOB from pleurisy

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17
Q

What is minimum amount of time takes for troponin to be elevated

A

3hrs

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18
Q

How long can troponin be elevated for

A

Over 7 days

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19
Q

What enzyme gets immediately elevated in MI

A

CK-MB

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20
Q

How long does CK-MB stay elevated for

A

2-3 days

Note- if still elevated after this then recurrent infarcts

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21
Q

Which patients are you wary of with elevated troponin

A

Renal patients as troponin should be excreted here

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22
Q

What should do if patient with CKD presents with MI

A

Regulary repeat troponin and look at trend

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23
Q

What can troponin also be elevated in

A 
Note troponin equals cardiac damage
Coronary artery spasm
Aortic dissection-> iscahemia
Myocarditis
Cardiomyopathy
Trauma
HF
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24
Q

What will happen to LDH and cholesterol post MI

A

Drops and levels wont return to normal for a long time so must be assessed straight away if want to act on it

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25
Q

U&Es relevance post MI

A

Can cause arrythmia- potassium main concern

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26
Q

What conditions causing chest pain will CRP and ESR be elevated in

A

Costochondritis
MI
Dissection
Myopericarditis

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27
Q

Why is glucose so important in chest pain

A

T2DM can present for first time with symptom of silent MIs

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28
Q

What are you looking for chest pain eCXR

A 
Dissection- mediastinum widened
Boerhaaves- pneumomediastinum, effusion
Pneumothorax
Effusion
Pneumonia
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29
Q

Posterior MI on ECG

A

V1-V3 ST depression

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30
Q

How would aortic dissection appear on echo

A

False lumen

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31
Q

How to diagnose a boerhaves perforation

A

Chest radiograph with water soluble contrast agent like gastrograffin

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32
Q

If patient is vomiting in MI what drug must give

A

Metoclopramide

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33
Q

When do you only give oxyfen MI

A

O2 sats less than 94%

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34
Q

When are NSTEMI patients candidates for angioplasty

A 
Haemodynamically unstable
LVD
Ventricular arrythmias
New mitral regurg or VSD
NOT candidates for thrombolysis
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35
Q

What score can be done to work out future care of NSTEMI patients

A

GRACE

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36
Q

Important secondary prevention post MI

A 
Glucose control
BP control
Lifestyle changes
Aspirin for life and clopidogrel for 1 year
ACEi for life
Beta blockers for 1 year
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37
Q

If in HF post MI what should be given

A

Aldosterone antagonist- spironactalone

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38
Q

When can ICD be considered post MI

A

Sign of conduction block

LVD

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39
Q

Complications of MI

A 
Death
Arryhtmia
Rupture
Tamponade
HF
Valve disease
Aneurysm
Dressler syndrome
Embolism
Reinfarction
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40
Q

What is dressler syndrome

A

Autoimmune pericarditis 2-10 weeks post MI

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41
Q

What is most common post Mi pericarditis

A

In the few days following

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42
Q

Treatment of pericarditis

A

Analgesia
NSAIDS
PPI to account for great number of NSAIDS
Also monitor kidney function due to NSAIDS

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43
Q

Main complication of pericarditis

A

Pericardial effusion

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44
Q

How to treat pericardial effusion

A

Pericardiocentesis

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45
Q

What is important to ask about that relieves chest pain

A

GTN

Antacids

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46
Q

Chest pain that isnt relieved by GTN

A

Must rule out oesophageal spasm

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47
Q

What is an oesophageal spasm

A

Strong spasms of oesophagus

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48
Q

How to diagnose oesophageal spasm

A

Barium swallow
Manometry
Trial of PPIs

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49
Q

If suffering angina symptoms but no angio/ECG symptoms what could be diagnosis

A

Prinzmetal angina

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50
Q

What is prinzmetal angina

A

Random coronary artery spasm

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51
Q

Other names for prinzmetal angina

A

Coronary syndrome X

Variant angina

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52
Q

Cardiac tamponade on examination

A

Muffled heart sounds

Distended neck veins

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53
Q

Main problem of arotic dissections

A

Tamponade

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54
Q

Difference between pericardial effusion and tamponade

A

Tamponades arise from effusion when ability of heart to contract is impaired by fluid

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55
Q

What could cause ST elevation with no angio signs

A

Artery spasm

56
Q

What causes coronary artery spasm

A

Cocaine

57
Q

Which MIs cause nausea and vomiting

A

Inferior as irritate diaphragm

58
Q

What can cause pleural effusion with severe chest pain

A

Boerhaves syndrome

59
Q

Complications of boerhaves syndrome

A 
Pneumomediastinum
Pleural effusion
Mediastinitis
Sepsis
Death 30%
60
Q

What is it called when inferior MI causes N&V

A

Bezold jarisch reflex

61
Q

Other than ST depression in V1-V3 in posterior MI what else can be seen

A

Tall R waves

62
Q

Why is troponin better than CK-MB

A

Specific to heart muscle

63
Q

What artery is involved in posterior MIs

A

Circumflex

64
Q

Which artery can be affected in lateral MI

A

LAD

Circumflex

65
Q

Initial investigations for angina

A

Exercise tolerance
Stress echocardiogram
Myoview scan
CT angio

66
Q

What do you do if any of the initial tests for angina are positive

A

Angioplasty

67
Q

Why would you do a stress echo

A

If patient has arthritis and cant do stress test

68
Q

What is a stress echo

A

Patient given dobutamine to simulate stress

69
Q

How will abnormal heart appear on stress echo

A

Normally a heart under stress will show increased motility but if not then will be hypokinetic

70
Q

What is a myoview scan

A

Can be done on exercise bike or under induced stress with patients injected with thallium a radioactive agent and pictures with gamma camera are taken

71
Q

What is normal on a myoview scan

A

Areas with good perfusion appear warm

72
Q

What is a CTangio

A

CT synced up to heart beat and given contrast to view vessels. Calcium in calcified atherosclerotic plaques can be visualised and the degree of stenosis noted

73
Q

ECG change seen minutes after occlusion

A

Hyperkalaemia- tented T waves

74
Q

How long does T wave inversion last post MI

A

Develops 1-2 days after and persists for months after

75
Q

If is ST depression or elevation in all chest leads what is affected artery

A

LCA

76
Q

What leads are affected in left circumflex problems

A

I
aVL
V5
V6

77
Q

Drugs used in stable angina

A 
ACEi
Statins
Aspirin
GTN spray
Anti anginals
78
Q

What are some anti-anginals

A

Beta blockers

CCBs

79
Q

Define unstable angina

A

Chest pain at rest due to ischaemia but wihtout cardiac injury

80
Q

What are precordial chest leads

A

Those on the chest

81
Q

ECG changes seen in STEMI

A

Hyperacute T waves
ST elevation
New LBBB

82
Q

Management of STEMI

A

Work out less than when symptoms started
If less than 12 hours do PCI if can do PCI within 120mins
If less than 12 hours and cant do PCI in 120mins do thrombolysis
If over 12 hours do angio then PCI if possible

83
Q

Management of NSTEMI immediately

A 
MONA
But also give LMWH 
Then use GRACE score to assess risk
If Low outpatient angio
If high inpatient angio with possible PCI and can give DOAC
84
Q

What is fondaparinux or enoxaparin

A

LMWH

85
Q

Causes of pericarditis

A 
Viral- cocksackie A9, EBV, mumps
Bacterial
CTD- sarcoidosis
AIs
Dressler syndrome
86
Q

Rfs pericarditis

A 
Male
20-50
Previous MI
Cardiac surgery
Cancer
Uraemia
87
Q

Where can pericarditis pain radiate

A

Trapezius sx

88
Q

How else can pericarditis present

A

Tamponade

89
Q

What is becks triad

A

Seen in cardiac tamponade

90
Q

Becks triad

A

Distended neck veins
Low BP
Muffled heart sounds

91
Q

How to manage pericarditis with tamponade

A

Pericardiocentesis

92
Q

How to manage pericarditis

A

NSAID and PPI(ulcer prevention)

Colchicine

93
Q

What drug can prevent chronic pericarditis

A

Colchicine

94
Q

Complications of pericarditis

A

Chronic constrictive pericarditis

Tamponade and effusion

95
Q

What is carotid sinus syndrome

A

Vasovagal syncope

96
Q

Cardiac red flags in syncope

A

LOC during exercise
Severe valvular disease
Previous arrythmia
Concerning ECG

97
Q

Signs on vasovagal syncope in history

A

Nausea
Pallor
Loss of hearing/vision
Light headed

98
Q

How to manage vasovagal syncope

A

Educate on triggers

Physical counter pressure movements

99
Q

What are physical counter pressure movements for vasovagal

A

Squatting
Isometric forearm grip
Leg crossing with buttocks and thighs tense

100
Q

Complications of AF

A

Thromboembolism

Worsened HF

101
Q

What must you do before AF cardioversion

A

Do TEE to see if IHD

102
Q

What are options for rate control in AF

A

Bisoprolol
Verapamil
Digoxin
Diltiazem

103
Q

What causes atrial flutter

A

Underlying heart disease

104
Q

What causes HBs

A 
IHD
Rheumatic fever
Drugs- CCB, b blockers and amiodarone
Metabolic- hyperkalaemia, hypothyroid
Sarcoid
105
Q

Symptoms of 1st HB

A

Asymptomatic

106
Q

Symptoms of T1 2 HB

A

Asymptomatic

107
Q

Symptoms of T2 2 HB

A 
Dizzy
Syncope
Dizzy
Chest pain
HF
108
Q

Symptoms of T3 HB

A 
Dizzy
Syncope
Dizzy
Chest pain
HF
109
Q

What is T1 2 HB also called

A

Mobitz

110
Q

What is T2 2 HB also called

A

Wenkerback

111
Q

Investigations for HB

A 
ECG
Troponin
K+, Ca2+
Digoxin toxicity
Echo
112
Q

Management for 3rd HB

A

Permenant pacemaker

113
Q

Management for acute HB secondary to MI

A

IV atropine

External pacing

114
Q

Complications for HB

A

Asystole
HF
Cardiac arrest

115
Q

Long term management of SVT

A

Ablation

116
Q

Management of VT haem stable

A

Amiodarone 300mg IV

117
Q

Management of VT haem unstable

A

If pulse DC cardiovert

118
Q

Causes of VT

A

Long QT
Electrolyte imbalances
Illicit drugs

119
Q

Main symptom of VF

A

Unconscious

120
Q

Causes of VF

A 
MI
Phaeos
Electrolye imbalances
Hypoxia
Acid base imbalances
Hyper or hypothermia
LongQT or brugada
121
Q

Rfs for WPW

A 
Ebsteins anomaly
Heart defect
Mitral valve prolapse
Marfans
Aortic coarctation
122
Q

Symptoms of WPW

A

Palpitations

Chest pain

123
Q

Management of unstable WPW

A

DC cardiovert

124
Q

Management of stable WPW

A

SVT management

125
Q

Long term management of WPW

A

Ablation to remove accessory

Anti-arrythmic

126
Q

Complications of WPW

A

Sudden cardiac death

Ablation SE

127
Q

Ablation SEs

A

Bleeding
Infection
Pneumothorax

128
Q

What is oesophagitis secondary to

A

GORD

Hiatus hernia

129
Q

Chest pain radiating to back ddx

A

Dissection
Pancreatitis
Pericarditis

130
Q

What can be immediate sign of MI on ECG

A

Hyperacute T waves

131
Q

How much ST elevation must there be for a man over 40

A

Over 2mm

132
Q

How much ST elevation must there be for a man under 40

A

Over 2.5mm

133
Q

How much ST elevation must there be for a woman

A

Over 1mm

Over 1.5mm in V2/3

134
Q

What must be there to confirm a STEMI

A

ST elevation in at least 2 leads

Meets mm guidelines

135
Q

Bloods ordered in MI

A 
FBC
U&Es
CRP
Glucose
Lipids
Troponin
CK-MB
BNP
TFTs
Amylase
136
Q

Other than ST elevation what may be seen on ECG

A

New onsent LBBB

137
Q

What is lassitude

A

State of general unwell and tired

Year 3 Conditions (33 decks)

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