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Cardiovascular System > Chest pain and acute coronary syndromes > Flashcards

Chest pain and acute coronary syndromes Flashcards

1
Q

Name four groups of causes of chest pain?

A

Cardiac, Respiratory, Upper GI and musculoskeletal

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2
Q

Name two types of cardiac causes of chest pain

A

ischaemia

pericaditis

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3
Q

Describe the description of the pain in ischaemia

A

dull retrosternal central pain

can radiate to the jaw

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4
Q

Describe the description of the pericarditis pain

A

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 )

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5
Q

Two respiratory causes of chest pain?

A

Pneumonia and pulmonary embolism

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6
Q

Describe the pneumonia chest pain

A

chest pain off centre

will also have a temperature, cough and breathlessness

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7
Q

Describe the pulmonary embolism pain

A

Sharp and well localised

Worse with breathing or coughing

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8
Q

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

A

Acid reflux

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

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9
Q

Two types of musculoskeletal pain?

A

Rib fracture and costochondritis

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10
Q

Describe the pain in costochondritis

A

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

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11
Q

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

A

cardiac ischaemia

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12
Q

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

A

infection

pneumonia

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13
Q

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

A

costochondritis/rib fracture

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14
Q

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

A

PE

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15
Q

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

A

acid reflux

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16
Q

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

A

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

17
Q

What causes ischamic heart disease?

A

Atherosclerosis.

18
Q

Risk factors of ischaemic heart disease?

A

Age
Family history

Smoking
hypertension
diabetes
obesity
sedentary lifestyle
19
Q

What is an atherosclerosis?

A

lipid laden core with fibrous external cap

20
Q

When does heart tissue ischaemia occur?

A

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

21
Q

Describe the pain of stable angina

A

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

22
Q

Define what is meant by acute coronary syndrome

A

An acute myocardial ischaemia caused by atherosclerotic coronary artery disease

23
Q

Describe how myocardial ischaemia can worsen

A

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

24
Q

Name three acute coronary syndromes, and 1 not

A

Stable angina is not

Unstable angina
STEMI
NSTEMI

25
Q

describe the pain in unstable angina

A

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

26
Q

What is the risk of unstable angina

A

Deterioration to a STEMI or NSTEMI

27
Q

Describe the pain in MI

A 
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
28
Q

Describe two diagnostic tests for ACS?

A

ECG

Clood test- troponin

29
Q

Describe what would be seen on the STEMI ECG

A

ST elevation

Big T waves

30
Q

What would you see in NSTEMI and Unstable angina

A

Patterns of ischaemia

ST depression and T wave flattening or inversion

31
Q

How would you distinguish between Unstable angina and NSTEMI

A

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

32
Q

Pathophysiological difference between STEMI and NSTEMI

A

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

Cardiovascular System (15 decks)

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