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Cardiovascular System > Chest Pain and Acute Coronary Syndrome > Flashcards

Chest Pain and Acute Coronary Syndrome Flashcards

1
Q

What are the causes of chest pain (classify them into groups)

A

Cardiac/vascular

Respiratory

MSK

Upper GI

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2
Q

What are the cardiac/vascular causes of chest pain

A

MI - myocardial infarction

Angina - myocardial ischaemia

Pericarditis

Aortic dissection

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3
Q

What are the respiratory causes of chest pain

A

Pneumonia

Pleurisy

Pneumothorax

Pulmonary embolism

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4
Q

What are the MSK causes of chest pain

A

Rib #

Costochondritis

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5
Q

How can you distinguish between cardiac and pleuritic chest pain

A

Cardiac - dull, poorly localised pain, worsened with exertion

Pleuritic (pleural/pericardial) - sharp, often well localised pain, worse with inspiration, coughing or positional movement

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6
Q

Patient presents with a dull, diffuse pain around the chest, what type of chest pain is it

A

Cardiac

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7
Q

Patient presents with a sharp and localised pain in the chest, what kind of chest pain is it

A

Pleuritic

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8
Q

What are the GI causes of chest pain

A

Reflux

Peptic ulcer disease

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9
Q

What is pericarditis and how does it present

A

Inflammation of the pericardium, often secondary to viral illness

Presents with:

A sharp, retrosternal pain, localised to the front of the chest

Aggravated with inspiration, coughing and lying flat and eased with sitting up and leaning forward

A pericardial rub may be heard on auscultation

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10
Q

What appears on an ECG with a patient with pericarditis

A

Widespread, saddle-shaped ST elevations

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11
Q

What are the risk factors for ischaemic heart disease

A

Same for risk factors for atherosclerosis

Modifiable

  • Smoking, hypertension, dyslipidaemia, diabetes, obesity, sedentary lifestyle

Non-modifiable

  • Advanced age, family history, male
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12
Q

What is stable angina

A

Where the heart tissue only becomes ischaemic when the metabolic demands of the cardiac muscle are greater than what can be delivered via the coronary arteries

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13
Q

How does stable angina present

A

Dull, central chest pain

Pain comes on with exertion and relieved by rest

Pain may or may not radiate to the shoulder, jaw or arm

Not typically associated with autonomic features

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14
Q

What is an acute coronary syndrome

A

Acute MI caused by atherosclerotic coronary artery disease

Atheromatous plaques rupture with a thrombus formation, causing an acute increased occlusion leading to ischaemia and potentially myocardial infarction

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15
Q

What diseases does acute coronary syndrome include

A

Unstable angina

Myocardial infarction (MI)

Non-ST elevation MI (NSTEMI)

ST elevation MI (STEMI)

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16
Q

How can you differentiate between unstable angina, NSTEMI and STEMI

A

Use a troponin assay to distinguish between unstable angina and STEMI/NSTEMI

Then use an ECG to distinguish between STEMI and NSTEMI. NSTEMI likely to have ST depression and/or T wave inversion. SETMI shows ST elevation

17
Q

What is a typical patient history for unstable angina

A

Dull chest pain, occuring at rest

Pain may be more intense

Pain may radiate to shoulder, jaw or arm

Pain may last longer - limited duration

Worsens with exertion

Not typically associated with autonomic features

18
Q

What is a typical patient history of MI

A

Dull, central chest pain

May radiate to shoulder, jaw or arm at rest

Increased severity of pain (when compared to angina)

Can have ANS activation, with nausea and sweating

Patient may or may not be breathless

19
Q

What ECG changes are seen in both unstable angina and NSTEMI

A

ST segment depression

T wave flattening or inversion

20
Q

How can you investigate an ACS

A

Use an ECG to look for ST elevation/depression, T inversion

Use invasive coronary angiogram to see if there are any occluded or stenosed coronary arteries

Troponin assay - see if the troponin level is raised

21
Q

What methods are used to see where the ACS happened

A

ECG:

  • Inferior changes - right coronary
  • Anterior changes - left anterior descending
  • Lateral changes - diagonal, obtuse marginal or circumflex

Invasive angiogram - identifies stenosis / occlusion / dissection in specific vessel

Echocardiogram - regional wall motion abnormalities can correlate with occlusion/stenosis territory

22
Q

Which chest leads of an ECG show the anteroseptal side of the heart

A

C1 - C4

23
Q

Which chest leads of an ECG show the lateral side of the heart

A

C5 and C6

Cardiovascular System (16 decks)

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