Chest Pain And IHD Flashcards
What are possible respiratory causes of chest pain and how may the pain be described?
Infection (pneumonia)
Pulmonary embolism
Pneumothorax
All give lateral chest pain, worse on inspiration and coughing, other respiratory symptoms such as fever, coughing, sputum.
What are possible GI causes of chest pain and how may the pain be described?
Reflux oesophagitis - burning pain
Gastric/gall bladder/pancreatic disease.
Pain radiates upwards and is worse when lying down, other GI symptoms present.
What are possible MSK causes of chest pain and how may the pain be described?
Trauma - history of trauma/excessive use
Muscle pain - often localised, tenderness
Bone metastases - movements may increase pain
What are possible CVS causes of chest pain and how may the pain be described?
Myocardial ischaemia - tightening pain
Pericarditis - sharp pain
Aortic dissection - tearing pain
What is stable angina and what is it caused by?
Chest pain in exertion.
Caused by atherosclerotic plaques building up in coronary vessels, occluding more lumen, leaving less space for the passage of blood, leading to ischaemia of the myocardium. Pain occurs when lumen occluded >70%
What is unstable angina and how is it caused?
Chest pain at rest or with minimal exertion. More severe, prolonged and frequent than stable angina.
Atherosclerotic plaque builds up leading to increased occlusion of the lumen in the coronary vessels.
How would you treat stable angina?
Treat acute episodes with a sublingual nitrate spray/tablet.
To prevent acute episodes use B-blockers, Ca channel blockers, organic nitrates.
To prevent cardiac events use aspirin, statins, ACE inhibitors
Long term: consider revascularisation
What is a myocardial infarction and how is it caused?
Complete occlusion of a coronary vessel, leading to an infarction (death) of the myocardium it supplies.
Very severe ischaemic chest pain, persistent at rest, patient may be breathless, faint & have autonomic features.
Can be due to plaque rupture, thrombus formation, leading to an embolism.
What is a NSTEMI?
Non ST elevated myocardial infarction, where the infarct is not the full thickness of the myocardium.
What is a STEMI?
ST elevated myocardial infarction, where the infarct is the full thickness of the myocardium.
What is acute coronary syndrome?
A group of symptoms that occur due to the obstruction of coronary arteries as a result of unstable Angina, NSTEMI & STEMI
How can you distinguish between unstable angina, NSTEMI and STEMI?
Unstable angina gives no biochemical markers in the blood, the others give troponin.
Unstable angina may have ST depression & T wave inversion, STEMI has ST elevation.
Unstable angina and NSTEMI are partial occlusion by thrombus, STEMI is full occlusion.
