Chest Pain - FM

Question 1

What is the leading cause of death?

Answer 1

Heart disease.

Question 2

How is Acute Coronary Syndrome (ACS) defined?

Answer 2

ACS is a constellation of symptoms related to obstruction of coronary arteries, with chest pain being the most common symptom.

Question 3

What is the most common symptom of ACS?

Answer 3

Chest pain.

Question 4

How does ACS-related chest pain typically present?

Answer 4

It radiates to the left arm or jaw, is pressure-like in character, and is associated with nausea and sweating.

Question 5

What are the three main classifications of ischaemic heart disease?

Answer 5

Stable angina, unstable angina, myocardial infarction.

Question 6

Name three non-cardiac causes of chest pain.

Answer 6

Costochondritis, pleurisy, diaphragmatic irritation.

Question 7

Where is the heart located?

Answer 7

In the middle mediastinum.

Question 8

What are the three layers covering the heart?

Answer 8

Fibrous pericardium, outer parietal serous pericardium, inner visceral pericardium.

Question 9

Which heart chamber forms the apex?

Answer 9

Left ventricle.

Question 10

Which heart chamber forms the base?

Answer 10

Left atrium, with a small part of the right atrium.

Question 11

Name the four main components of the cardiac conduction system.

Answer 11

SA node, AV node, Bundle of His, Right & Left bundle branches.

Question 12

What is the pathophysiology of ACS?

Answer 12

Atheromatous plaque formation, plaque rupture, platelet aggregation, clot formation, coronary occlusion, myocardial infarction.

Question 13

List three modifiable risk factors for ACS.

Answer 13

Smoking, high cholesterol, physical inactivity.

Question 14

List three non-modifiable risk factors for ACS.

Answer 14

Gender, age, family history of cardiovascular disease.

Question 15

What are the key clinical features of ACS?

Answer 15

Chest discomfort (tightness, heaviness) at rest, dyspnoea, diaphoresis, dizziness, nausea, vomiting.

Question 16

How is ACS classified based on ECG and cardiac enzymes?

Answer 16

STEMI (ST elevation, elevated cardiac enzymes), NSTEMI (ST depression, T-wave inversion, elevated enzymes), Unstable Angina (nonspecific ECG, normal enzymes).

Question 17

What are the ECG changes seen in STEMI?

Answer 17

ST elevations, Q waves, hyperacute T waves, followed by T wave inversions.

Question 18

What are the ECG changes seen in NSTEMI?

Answer 18

ST depressions or T wave inversions without Q waves in at least two contiguous leads.

Question 19

Which ECG leads indicate an inferior wall MI?

Answer 19

Leads II, III, aVF.

Question 20

Which ECG leads indicate an anterior wall MI?

Answer 20

Leads V1, V2, V3, V4.

Question 21

Which ECG leads indicate a lateral wall MI?

Answer 21

Leads I, aVL, V5, V6.

Question 22

Which artery is usually blocked in a lateral wall MI?

Answer 22

Circumflex artery.

Question 23

What is the primary biomarker for ACS diagnosis?

Answer 23

Troponin.

Question 24

What drugs are used in the management of ACS?

Answer 24

Oxygen, nitrates, beta-blockers, morphine, aspirin, clopidogrel, statins.

Question 25

What are the key components of the primary survey in ACS?

Answer 25

Airway (assess patency, SpO2), Breathing (ventilation, oxygen therapy), Circulation (IV access, capillary refill, urine output), Disability (GCS, blood sugar), Environment (prevent hypothermia).

Question 26

What are the immediate steps to take when a patient presents with ACS?

Answer 26

Call for help, perform a 12-lead ECG, insert IV cannula, give pain relief, administer aspirin/clopidogrel, and assess bleeding risk.

Question 27

What are the key interventions within 10 minutes of ACS presentation?

Answer 27

ECG within 10 minutes, pain management, O2 therapy, call cardiologist.

Question 28

Describe the clinical case of a 60-year-old male with ACS.

Answer 28

60-year-old male with DM, HTN, HLD, presents with anterior chest pain relieved by sitting, worsened by exertion. BP 84/56, HR 95.

Question 29

What are the key components of ACS resuscitation?

Answer 29

Early identification, ECG, aspirin, resuscitation, escalation of care, calling a cardiologist.

Question 30

What are the essential steps in ACS diagnosis and triage?

Answer 30

High suspicion, clinical evaluation, ECG analysis, triage, resuscitation, timely escalation.