Chest Pain And Acute Coronary Syndrome Flashcards
What are the four main systems that could cause chest pain?
Cardiac (circulatory)
Respiratory
GI (digestive)
Musculoskeletal
How does pleural/pericardial chest pain compare to cardiac ischaemic chest pain?
Pain from the pericardial sac is “somatic”/ specific -it is sharp, well localised and is often worse with inspiration, coughing or positional changes
Pain from the heart itself is “visceral”/ non-specific it is dull and poorly localised and worsens with exertion
What are some differentials for non-cardiac chest pain?
Pneumonia, pleurisy, PE
Reflux, peptic ulcer disease
Costochondritis, rib fracture
Aortic dissection
What is stable angina?
Angina that occurs as a result of heart tissue ischaemia ONLY when metabolic demands of cardiac muscle are greater than what can be delivered via the coronary arteries (on exertion)
What is the typical patient history of someone with stable angina?
Dull, reterosternal chest pain
Triggered by exertion and goes away completely at rest
GTN spray will relieve the pain
Won’t be sweaty/pale
Name all of the acute coronary syndromes
Unstable angina
Myocardial infarction
Non-STelevation MI
STelevation MI (STEMI)
What are acute coronary syndromes?
Acute myocardial ischaemia caused by atherosclerotic coronary artery disease (atherosclerosis, thrombus formation, occlusion)
Would we see raised troponin levels in a patient with unstable angina? Why?
No, the heart tissue is ischaemic, not dead and therefore there is no cardiac enzyme leak
Would we expect to see raised troponin in NSTEMI/STEMI?
Why?
Yes
Heart tissue death (infarction) has occurred and therefore cardiac enzymes can leak from the necrosed cardiac myocytes
What is the typical patient history of a patient with unstable angina?
What is there a risk of if patients present with these features?
Dull, reterosternal chest pain That occurs at REST GTN spray doesn't work at relieving pain May last longer than unstable angina RISK OF STEMI/NSTEMI need to be admitted
What is the typical patient history of a patient with MI ?
Dull, reterosternal cheat pain Much more severe than angina pain Radiates to neck/shoulders/lt arm Pain occurs at rest Sweating, pale, nauseous Nothing helps ease pain Pain persists >15 min
What diagnostic tests might be used in suspected acute coronary syndrome?
ECG - ST segments, T waves +/- pathological Q waves
Blood tests - troponin
True or false, it is always possible to spot acute coronary syndromes on clinical examination
FALSE! Often clinical examination is normal- nothing abnormal to hear with stethoscope
How would the pattern STEMI show on an ECG?
ST segment elevation
Hyperacute T waves (big and pointy)
What ECG changes might you see in a patient with unstable angina/ NSTEMI?
How would you distinguish between the two?
ST segment depression
T wave flattening or inversion
Test troponin levels
