Chest Pain And Coronary Syndromes Flashcards
What things can we do to try and reach a diagnosis?
- History
- Clinical examination
- Investigations
What investigations found be done on a patient with chest pain?
ECG
Blood tests - Troponin, something else (full blood count - infections)
Chest X-rays
What is SQUITARS?
SQITARS is the criteria we used to assess pain.
Site - location of the pain and if it radiates
Quality - How pain feels (sharp, dull)
Intensity - effect on patient, severity score
Timing - when it started, sudden or gradual onset
Aggravating factors - what makes pain worse
Relieving factors - what makes pain better
Secondary symptoms - other symptoms.
What are some cardiac causes of chest pain?
- Myocardial Infarction
- Myocardial Ischaemia - angina
- Both these can present with a dull, central chest pain, both affect the blood supply and both radiate to the shoulder, the neck and the jaw.
- Pericarditis
- Aortic Dissection - Pain presents more in the back as a sharp, tearing pain,
Wear are some respiratory causes of chest pain?
- Pneumonia - sharp, worse when breathing
- Pleurisy - often seen with pneumonia
- Pericarditis - pericardial sac is inflammed. Breathing in makes it worse
- Pneumothorax - lung collapse, hear breathlessness and chest X-ray. Predisposed if you have an underlying lung problem such as COPD.
- Pulmonary Embolism - occurs from a DVT, breathless, sharp and localised pain, acute onset of pain
What are some MSK causes of chest pain?
- Fractured ribs - localised inflammation / pain
- Costochondrits - localised and tender, inflammation of the costal margins.
What are some upper GI causes of chest pain
- Reflux
- Peptic Ulcer disease
What is the difference between cardiac and pleuritic chest pain?
Cardiac - From heart and causing ishaemia
Pleuritic - From pleural or pericardial sac
What are the features of cardiac chest pain?
- Visceral chest pain (from internal organs, can be referred pain)
- Dull, poorly localised, heavy
- Worsened with exersion
- Around centre of chest
What are the features of pleuritic chest pain?
- Somatic pain (from joints, bones, muscles and soft tissues)
- Sharp pain, often well localised
- Worse with inspiration, coughing ir positional movements.
What is pericarditis?
- Inflammation of the pericardium
- more common in men and adults
- Often secondary to a viral illness
- Presents with chest pain
- Retrosternal (centre and behind sternum)
- Sharp pain, localised to front of chest
- Aggrevated with inspiration, cough, lying flat
- Eased with sitting up and leaning forward
- Pericardial rub may be heard on auscultation
What is cardiac (Ischaemic) chest pain?
- Pain secondary to pathology involvinf the heart
- Ischaemic heart disease
- Potentialy a life-threatening cause of chest pain
What is the pathophysiology of ischaemic heart disease?
Atherosclerosis causes ischaemic heart disease.
Atherosclerosis builds up over time. These plaques are made of a lipid-laden core with a fibrous external cap.
What are the risk factors of ischaemic heart disease?
Risk factors for atherosclerosis are also risk factors for ischaemic heart disease as atherosclerosis causes IHD.
Modifiable:
- Smoking
- Hypertension
- Dyslipidaemia (Abnormal amount of lipids in the blood)
- Diabetes
- Obesity
- Sedentary lifestyle
Non-modifiable:
- Advanced age
- Family history (of early IHD)
- Male
What is stable angina?
Heart tissue ischaemia only occurs when the metabolic demands of cardiac muscle are treated than what can be delivered via coronary arteries e.g. on exertion
Stable angina occurs when the atherosclerotic plaque is stable.
Typical patient history:
- Dull, central pain
- Cone on with exersion and relieved by rest
- May (may not) radiate to neck / shoulder
- Not associated with autonomic features (sweating, nausea)
How do acute coronary syndromes occur?
- Atherosclerotic plaque rupture
- Platelet addregation and formation of a thrombus
- Partially or Completely occlusive thrombus (the degree of occlusion depends on whcih acute coronary syndrome it is
- Unstable angina = Heart tissue ischaemia but no cardiac enzyme leak (partial occlusion)
- NSTEMI = Heart tissue death (infarction) and cardiac enzymes leak from necrosed cardiac muscle cells. (Althoguh not complete occlusion)
- STEMI = complete occlusion (worse of the three). Heart tissue death (infarction), Cardiac enzymes leak from necrosed cardiac muscle cells.
