Chest pain and acute coronary syndromes

Question 1

Name four groups of causes of chest pain?

Answer 1

Cardiac, Respiratory, Upper GI and musculoskeletal

Question 2

Name two types of cardiac causes of chest pain

Answer 2

ischaemia

pericaditis

Question 3

Describe the description of the pain in ischaemia

Answer 3

dull retrosternal central pain

can radiate to the jaw

Question 4

Describe the description of the pericarditis pain

Answer 4

Central, retrosternal, sharp pain
Eased with sitting up and leaning forward
Worse when lying flat
Pericardial rub may be heard on auscultation (A very coarse sound )

Question 5

Two respiratory causes of chest pain?

Answer 5

Pneumonia and pulmonary embolism

Question 6

Describe the pneumonia chest pain

Answer 6

chest pain off centre

will also have a temperature, cough and breathlessness

Question 7

Describe the pulmonary embolism pain

Answer 7

Sharp and well localised

Worse with breathing or coughing

Question 8

What is the cause of upper Gi cause of chest pain. Describe the type of pain.

Answer 8

Acid reflux

A burning pain, felt centrally sometimes moving upwards, and worse when lying flat or after eating

Question 9

Two types of musculoskeletal pain?

Answer 9

Rib fracture and costochondritis

Question 10

Describe the pain in costochondritis

Answer 10

Firstly, this is inflammation of the costal cartilage
the pain is sharp, well localised and tender to palpate
worse with coughing or inspiration

Question 11

Patient comes in. Complains of dull, retrosternal pain. radiating to jaw, neck and shoulders.

Answer 11

cardiac ischaemia

Question 12

Patient comes in. Complains of off centre chest pain. Also has a fever, cough and breathlessness

Answer 12

infection

pneumonia

Question 13

Patient comes in. Complains of sharp well localised pain that is tender to palpate and worse with coughing and inspiration

Answer 13

costochondritis/rib fracture

Question 14

Patient comes in. Complains of sharp, well localised pain. Breathless and worse with breathing and coughing. not tender to palpate

Answer 14

PE

Question 15

Patient comes in. Complains of burning pain felt centrally. Worse after eating

Answer 15

acid reflux

Question 16

What is the difference between somatic pain and visceral pain. define each

Answer 16

somatic- Pericardial/pleural
Visceral- Lung or heart tissue

Somatic- Sharp, well localised, worse with movement (breathing and coughing included)

Visceral pain- Dull, poorly localised. worse with exertion

Question 17

What causes ischamic heart disease?

Answer 17

Atherosclerosis.

Question 18

Risk factors of ischaemic heart disease?

Answer 18

Age
Family history

Smoking
hypertension
diabetes
obesity
sedentary lifestyle

Question 19

What is an atherosclerosis?

Answer 19

lipid laden core with fibrous external cap

Question 20

When does heart tissue ischaemia occur?

Answer 20

When metabolic demands greater than what can be delivered by coronary arteries

Question 21

Describe the pain of stable angina

Answer 21

dull retrosternal pain
triggered by exertion, relieved by rest
GTN spray will relieve pain

Question 22

Define what is meant by acute coronary syndrome

Answer 22

An acute myocardial ischaemia caused by atherosclerotic coronary artery disease

Question 23

Describe how myocardial ischaemia can worsen

Answer 23

athromatous plaque ruptures
causes thrombus formation
there’s an acute increase in occlusion(Note its already partially occluded) that leads to worsening ischaemia

Question 24

Name three acute coronary syndromes, and 1 not

Answer 24

Stable angina is not

Unstable angina
STEMI
NSTEMI

Question 25

describe the pain in unstable angina

Answer 25

pain at rest pain more intense pain lasts longer GTN spray no longer relieves pain

Question 26

What is the risk of unstable angina

Answer 26

Deterioration to a STEMI or NSTEMI

Question 27

Describe the pain in MI

Answer 27

``` Dull, retrosternal, central chest pain thats very severe can radiate to neck and shoulder chest pain at rest you'll be sweaty, pale, and nauseous pain lasts more tha 15mins ```

Question 28

Describe two diagnostic tests for ACS?

Answer 28

ECG | Clood test- troponin

Question 29

Describe what would be seen on the STEMI ECG

Answer 29

ST elevation | Big T waves

Question 30

What would you see in NSTEMI and Unstable angina

Answer 30

Patterns of ischaemia | ST depression and T wave flattening or inversion

Question 31

How would you distinguish between Unstable angina and NSTEMI

Answer 31

Blood test for troponin not released in unstable andina (No necrosis) Released in NSTEMI

Question 32

Pathophysiological difference between STEMI and NSTEMI

Answer 32

STEMI: Complete occlusion of major coronary artery-->full thickness damage NSTEMI: complete occlusion of minor artery or partial occlusion of major artery-->partial thickness damage