Chest Pain COPY Flashcards
What is the breakdown of Ischaemic Heart disease categories?
Vasospastic = Prinzmetal Angina
All else atherosclerotic
Then stable angine or ACS
ACS broken into unstable angina and STEMI and NSTEMI
RFs for IHD?
HTN
Smoking
Diabetes
FHx
PMHx
Hyperlipidaemia
Stable angina presentation, Ix and management?
Normal on resting examination
Bloods = lipids, FBC and glucose
ECG
Conservative: weight loss, improved diet and smoking cessation
Medical = drugs:
ACEi, antiplatelete.g. aspirin, statins, anti-anginals e.g. Beta-blocker/CCB
GTN spray
Unstable and NSTEMI ECG features?
Normal, inverted T waves or ST depression
NSTEMI has elevated tropomin
ACS signs and symptoms?
Acute central chest pain (grip[png or heavy) +/- radiation to neck,arm,jaw
Sweating
Pallor
+/- SOB
CAN BE SILENT IN OLD or DM
ACS Ix?
ECG and troponins
Coronary anatomy and ECG leadfs?
Anterior/septal leads V1-V4 = LAD
Lateral leads I,aVL V5V6 = LCx or diagonal of LAD
Inferior leads 2,3,aVF = RCA and or LCx
Anterolateral MI V1-V6 - LCA
Posterior MI ST depression V1-V4 = posterior descending
ECG changes in STEMI?
Hyperacute T waves
ST elevation and new LBBB
Old infarct ECG feature?
Pathological Q waves
STEMI management?
<12hrs and PCI in <2 hours = PCI
<12hours and PCI not <2 hours = thrombolysis
>12hours simnce onset = Angio and then possible PCI
Management:
Immediate = morphine, oxygen, nitrates, aspiring and clopidogrel
Long = Betablocker,ACEi and statin, heparin
NSTEMI management?
Same as STEMI but LMWH
Determine risk via GRACE score: low = angiography
Moderate high = angiography with possible PCI
STEMI Complications?
DARTH VADER
Death
Arrhythmia
Rupture
Tamponade
HF
Valve disease
Aneurysm
Dresslers syndrome
Embolism
Reinfarction
Causes of pericarditis?
ABCDIVM
Idiopathic
Viral e.g. Coxsacki, mumps, ebv
Bacterial e.g. pneumococcus, staph, strep
Connective tissue e.g. sarcoidosis
Autoimmune e.g. SLE, RA
Dressler syndrome (2-10 week post MI
Malignancy
RFs for pericarditis?
Male, 20-50, transmural MI, cardiac surgery, neoplasm and uraemia or dialysis
Pericarditis signs and symptoms?
SHarp, stabbing pleuritic chets pain
May be releive leaning forward, May radiate to trapezius ridge
Corysal Symptoms if viral
pericardial friction RUB
Tamponade = becks triangle
What is becks triangle?
Low arterial BP, distended neck veins, muffled heart valves. indicate tamponade and constrictive pericarditis
Pericarditis Ix?
ECG showing widespread saddle shaped ST elevation
Or widespread PR depression
Spodicks sign (downsloping TP segment)
Bloods and CXR for pericardial effusion
Pericarditis management?
NSAID + PPI + Cochicine + exercise restriction if viral
Tamponade or purulent = pericardiocentesis + AB as well as above
Complication of pericarditis?
Pericardial effusion +/- tamponade
Chronic constrictive pericarditis
Categories of syncope?
1) arrhythmia related (due to CO compromise e.g. VT or heart block)
2) Cardiac = structural heart disease most notably LV outflow obstruction (HOCM, sevre AS, PE, aortic dissection)
3) Orthosatic
Reflex (reflex vasodilation/bradycardia due to trigger e.g. vasovagal or carotid sinus syncope)
How to differentiate syncope types?
1) establish LOC with no seizures
2) determine cardiac red flag symptoms
3) Ix
ECG, imaging for PE or aortic dissection, ECHO for cardiac syncope. BP for orthostatic
Negative IX = orthostatic
What are the cardiac red flags?
LOC during exertion
Severe valvular disease
Previous arrhythmia
Concerning ECG
RFs for vasovagal syncope?
Prior syncope, emotional stress, prolonged staning, heat and excessive dehydration
Presentation, Ix and management of vasovagal syncope?
Nausea, pallor, light headed, diminished hearing/vision. physical injury
ECG and bloods
Patient education on triggers with physical counter pressure manouevres
RFs for AF?
HTN, heart failure, diabetes, obesity, alcohol use and hyperthyroid
Causes of AF?
Idiopathic, coronary artery disease, thyroid, COPD< electrolyte disturbance and pneumonia
Types of AF?
Paroxysmal AF terminates within 7 days
Persistent AF terminates after 7 days
AF signs and investigations?
Palpitations, irregularly irregular pulse rate, sob and chest pain
ECG showing Irrgularly irregular with no p waves
Bloods
CXR and TEE for valve disea
Complications of AF?
Thromboembolism or worsened HF
How to treat AF?
<48 hours and haemodynamically stable = Rhythm control = DC cardioversion of chemical via fleicanide or amiodarone
> 48 hours haemodynamically stable then anticoagulation with LMWH + warfarin and rate control bisprolol, verapamil, diltizem and digoxin
If haemodynamically unstable = DC cardioversion
Atrial flutter causes and ECG + symptoms?
Underlying heart conditions causijg Saw tooth pattern with loss of isolelectric baseline and p waves
Same signs, symptoms and manegement as AF
Causes of heart block?
MI/IHD
infection = rheumatic fever
Drugs e.g. beta blockers, CCB, amiodarone
Metabolic = hyperkalaemia, low T4
Sarcoidosis
Signs and symptoms of heart block?
1st and 2nd type 1 = asymptomatic
2nd type 2 and 3rd = dizzy, palpitations, chest pain and heart failure
May have stokes-adams attacks which are syncope due to ventricular asystole
Ix for Heart block?
ECG, troponins, K+, Ca2+, pH, digitalis toxicity and echo
Management for heart block?
Chronic = pacemake for mobitz 2 for 3rd degree
Acuet 2nd to MI = IV atropine and external pacemaking
Complications of heart block?
Asystole, heart faliure and cardiac arrest
SVT signs and symptoms + types?
Regular narrow complex tachycardia with no p waves >100bpm
AVRT = accesory pathway from ventricles back to atria
AVNRT = accesory pathway from AV node to atria (bundle of kent in WPW)
Palpitations
Syncope
SOB and CHest pain
SVT Ix and management?
ECG and bloods
Vagal manouvres, adenosine and ablation
Digoxin and verapmil containdicated in AVRT
NO adenosine in astma so use verapamil
VT causes and Ix?
Regular ,wide complex tachycardia with no p waves
Long QT syndrome, electrolyte imbalance or illicit drugs
ECG and bloods
VT signs and symptoms?
Chest pain, dizziness, fainting, sudden death, pallor and hypotension
Management of VT?
Stable = amiodarone 300mg IV
Unstable = DC cardioversion
Type of polymorphic VT and how to remove QT prolongation?
Torsades de Pont
Magnesium and phenytoin
VF causes?
MI, increased catecholamines, electrolyte imbalance, hypoxia, acid-base distribance, hyper or hypothermia and congenital conditions e.g. QT syndrome or brugada
ACCEHHM
SS of VF and Ix?
Chest pain, dizzy, sob and unconscious
Time dependent Ix but ECG and bloods
Managment of VF?
Commense CPR/cardiac arrest protocol immediately
IV adrenaline and iv amiodarine after 3 shocks.
Treat reversible causes: 4 Hs and 4Ts
4Hs and Ts of Cardiac arrest
Hyperkalaemia
Hypo/hyperthermia
Hypovolaemia
Hypoxia
Tension pneumothorax
Tamponade
Toxic
Thromboembolism
Causes of WPW?
EBSTEINS ANOMAL
heart defect e.g VSD, dextrocardia, great vessel transpostition
mitral valve prolapse
coarctation of aorta
Marfans
SS of WPW?
Palpitations, dizzy, chest pain, SOB
WPW Ix?
ECG showing sluured upstroke (delta wave) on with short PR
ECHO for structural disease
Management of WPW?
Unstable = DC cardioversion
Stable = vagal mouvres -> IV adenosin -> DC cardiovert
Long term = ablation or anti-arrhythmic = amiodarone,procainamide
Complications opf WPW?
Sudden cardiac death
Ablation SE e.g. bleeding, infection, pneumothorax
