Chest Pain and Acute Coronary Syndrome Flashcards
Name the 4 common categories of causes of chest pain
Respiratory
Cardiac
Upper gastrointestinal
Musculoskeletal
State respiratory causes of chest pain
Pneumonia - temperature, cough, breathlessness
Pulmonary embolism - sharp, well-localised chest pain
Worse during inspiration or coughing
State cardiac causes of chest pain
Ischaemic
Pericarditis
State gastrointestinal causes of chest pain
Reflux - indigestion, acid reflux
Burning pain running up chest or centrally, worse after food, worse lying flat
State musculoskeletal causes of chest pain
Rib fracture
Costochondritis - inflammation of costal cartilage (where ribs insert into sternum)
Sharp pain, well localised, tender to palpate (more pain), worse with movement of chest wall (coughing, inspiration)
Differentiate between somatic and visceral pain
Somatic pain seen in pleural sac and pericardial sac inflammation
Sharp pain, often well localised
Worse with inspiration, coughing or positional movement
Visceral pain seen in damage to lung and heart tissue
Pain carried in autonomic nerve - not well localised
Dull, poorly localised pain
Pain worsened with exertion
Describe the risk factors of coronary atheroma
Modifiable risk factors include: Smoking Hypertension Hypercholesterolaemia Diabetes Obesity Unmodifiable risk factors include: Advanced age Family history Male
Describe the signs and symptoms of acute pericarditis
Inflammation of the pericardium
More common in men and adults
Often secondary to viral infection
Presents with chest pain
Pericardial rub - coarse harsh sound
Retrosternal, sharp pain
Pain eased with sitting up and leaning forward
Aggravated by lying flat, inspiration and coughing
Widespread saddle-shaped ST segment elevation
Describe the pathophysiology of stable angina
Body demands more nutrients and oxygen during exercise however blood vessels can’t cope with it, leading to ischaemia and chest pain
Dull pain in centre of chest (retrosternal), heaviness, not well localised, radiating pain (shoulder, jaw, neck), may be worse with exertion
No chest pain at rest
GTN relieves pain
Normally caused by coronary artery stenosis
Anginal symptoms may be caused by spasms, anaemia, severe aortic valve stenosis, severe hypertension, hypertrophic cardiomyopathy
Describe the pathophysiology of unstable angina
Presents similar to stable angina except pain occurs at rest, pain may be more intense and pain may last longer
Risk of deteriorating further to NSTEMI and STEMI
Causes include coronary plaque rupture
Treatment
Pharmacological, reperfusion - PCI, CABG
Describe treatment of stable angina
Aspirin - anti-platelet drug, prevent platelet from sticking together
Beta blocker - drop heart rate and drop blood pressure - reduce work of heart
Statin- reduce cholesterol
ACE inhibitor - reduce blood pressure
PCI - put stent inbetween plaque to keep artery open
Coronary artery bypass surgery
State the features of myocardial infarction
Dull, retrosternal chest pain More severe pain Radiating pain into neck and shoulders Chest pain at rest Look unwell Sweaty, pale, feeling nauseous Ongoing pain persists for more than 15 min Treatment Oxygen, pain relief, GTN, aspirin, reperfusion
Explain the concept of acute coronary syndrome
Acute myocardial ischaemia caused by atherosclerotic coronary artery disease
Atheromatous plaques rupture with thrombus formation causing an acute increased occlusion (in an already partially occluded lumen) leading to ischaemia
In heart tissue ischaemia, no cardiac enzymes leak
In infarction, cardiac enzymes leak from necrosed cardiac muscle cells (troponin)
Differentiate between unstable angina, Non-STEMI, and STEMI
Unstable angina is occlusion from lipid accumulation and rupture
Non-STEMI is significant occlusion leading to infarction symptoms
STEMI is full occlusion leading to myocardial infarction
Describe the investigations for myocardial infarction
ECG - changes suggestive of either ischaemia or infarction
STEMI suggestive of infarction, NSTEMI suggestive of ischaemia
Look at ST segments, T waves and pathological Q waves
Blood tests - troponin
