Chest Pain And Acute Coronary Syndromes Flashcards
What are some possible causes of chest pain that is non cardiac?
Skin
Musculoskeletal
Respiratory (Lungs and Pleura)
Gastrointestinal (Oesophagus)
Vascular (Aortic dissection)
In cardiac sources of chest pain, what may be being affected?
Heart
Pericardial sac
With cardiac chest pain, how is the pain experienced?
Centrally
What may cause cardiac chest pain?
Acute coronary syndromes
Stable angina
Pericarditis
What may cause respiratory/pleuritic chest pain?
Chest infection (pneumonia)
What symptoms would indicate pleuritic/respiratory source of chest pain? (Helps differentiate between a cardiac issue)
Cough
Temperature
Shortness of breath
Where would the pain likely be with a respiratory/pleuritic chest pain?
Lateral/anterolateral rather than central chest pain
With musculoskeletal chest pain, what is the pain like?
Well localised
Sharp
Worsened with inhaling or coughing
What are the 2 types of afferent nerves related to chest pain?
Somatic afferent nerves
Visceral afferent nerves
Why does cardiac (ischaemic) chest pain differ to pleuritic chest pain?
Have different types of innervation
Cardiac chest pain involves stimulation of visceral afferent nerves
Pleuritic chest pain involves stimulation of somatic afferent nerves
What is the type of pain experienced with cardiac chest pain?
Dull pain
Felt centrally
Poorly localised (Pain can be referred to as coming from another location like the shoulder)
What segments do the visceral afferent nerves plug into at the spinal cord which innervate the heart?
T1 - T4/T5
Why can (ischaemic) cardiac chest pain lead to pain radiating to the shoulders/arm?
Brain does no expect to receive pain signals from the visceral afferent nerves of the heart, so it gets confused and thinks its receiving signals from the somatic afferent nerves from the skin. So the patients thinks the pain is coming from the T1-T4/T5 Dermatome
What type of pain is experienced with Pleuritic chest pain?
Sharp
Well localised
No radiation
May:
-Worsen with position (pericarditis)
-Worsen with inspiration or coughing (respiratory or MSK cause)
Why is pleuritic chest pain well localised?
Supplied by somatic afferent nerves which brain expects
What type of sounding chest pain is likely if a chest pain is made worse when breathing deeply or when coughs??
There is tenderness over the left 4th intercostal cartilage
What type of cause is this?
Pleuritic sounding chest pain
MSK cause likely costochondritis
What may happen to the pericardium to cause chest pain?
Can become inflamed
PERICARDITIS (somatic afferents)
What worsens the cardiac chest pain caused by pericarditis?
Lying down
What relieves the cardiac chest pain of pericarditis?
Sitting up or leaning forward
What may be examined in a patient with pericarditis?
Can be normal
Could be Tachycardic
Pericardial rub once listened to with a stethoscope
What is a pericardial rub?
Sounds like when you put your hand over your ear and scratch the back of your hand
What would be observed in a blood test in a patient with pericarditis?
Inflammatory markers like elevated cRP
What may be observed on a an ECG of a patient with pericarditis?
Saddle shaped ST elevation which is widespread
Widespread meaning it is visible over all of the leads
How does the ST elevation seen in pericarditis different to a STEMI?
STEMI ST elevations would only be visible in the leads which view the specific section of the heart where the coronary artery is blocked causing the MI
Pericarditis would be seen over all 12 leads
