chest pain and acute coronary syndromes

Question 1

causes of chest pain

Answer 1

• respiratory - lungs and pleura
• gastro - intestinal - oesophagus (acid reflux)
• vascular - aortic dissection
• musculoskeletal - muscle, bone and cartilage (rib fracture)
• cardiac - heart (ischemic, pericardial sac)

Question 2

pain via different nerve innervations

Answer 2

Question 3

description of cardiac pain (ischameic)

Answer 3

• pain due to ischaemic or infarct
• stimulates visceral afferent nerve endings
• signals move through T1-T4/5 spinal cord segments
• brain interperates visceral (skin pain)
• dull pain, poorly localised (indicated with whole hand), can radiate to shoulder and jaw

Question 4

description of pleuritic chest pain

Answer 4

• pain from lung pleura/ pericardial sac/ msk structures
• stimulates somatic nerves
• somatic pain not visceral
• sharp, well localised (finger)

worsened with inspiration and coughing

Question 5

comparison of cardiac and peuritic chest pain

Answer 5

Question 6

causes of cardiac chest pain

Answer 6

• pericarditis
• acute coronary syndromes
• un/stable angina
• MI
• stable angina
• ischemic / infarcted

Question 7

pericarditis

Answer 7

• dull/ front of chest
• leaning forward alleviates pain / leaning back aggrevates
• clinical examination: scraping noise due to rubbing of pericardium
• carry out an ECG - lots of ST elevations everywhere
  *

Question 8

Acute Coronary syndrome

Answer 8

• unstable angina
• MI
• ST - elevation MI
• non - ST elevantion MI

Question 9

ischaemic heart disease

Answer 9

Question 10

pathophysiology of ischameic heart disease

Answer 10

risk factors:

atherosclerosis

Question 11

pathophysiology of ischaemic heart disease

Answer 11

1. stable (chronic) occulusion = stable angina
2. plaque rupture
3. thrombus formation
4. sudden increase in occlusion (acute coronary syndrome)
5. severity of occlusion determines if its an unstable angina, NSTEMI, STEMI

Question 12

difference between

stable angina vs UA, NSTEMI and STEMI

Answer 12

SA - no pain at rest

rest - pain at rest and can immediately threaten heart

Question 13

what chest pains are associated with a rise in troponin

Answer 13

• st elevation
• non st - elevation MI

Question 14

what to do if patient has a STEMI

(raised ST)

Answer 14

• send straight to catheter lab

Question 15

evolution of ECG waves in STEMI

Answer 15

Question 16

when is a troponin rise seen

Answer 16

in STEMI and NSTEMI

not in UA

Question 17

location of infarct

Answer 17

Question 18

type 1 MI

Answer 18

atherosclerotic rupture, ulceration = thrombus = reduced blood flow

Question 19

type 2 MI

Answer 19

condition other than a plaque that causes and imbalance between oxygen supply and demand

eg:

coronary artert spasm

anaemia

respiratory failure

hypotension

Question 20

EGC territories

Answer 20

top red = anteroseptal

Question 21

distinct features on ECG

Answer 21

• ST elevation - implies sudden occlusion
• ST depression - under supply of blood to myocardium but not sudden occlusion
• T wave inversion - under supply of blood to the myocardium but not sudden occulusion
• ST depression and T wave inversion - ischemia but not sudden occulusion

Question 22

what does STEMI and NSTEMI mean

Answer 22

NSTEMI - non ST elevation MI

STEMI - ST elevetion MI

Question 23

NSTEMI

Answer 23

• troponin T and I will be raised
• measured doing an immunoassay
• carry out an echocardiogram

Question 24

managing a STEMI

Answer 24

• asprin - dissolve clot
• morphine - help with pain
• take to cath lab

Question 25

managment of NSTEMI

Answer 25

• antiplatlets/ antithrombotic
• anti-ischaemics
• secondary prevention
• urgent PCI like a stunt