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KCP - sem 2 > chest pain (W4) > Flashcards

chest pain (W4) Flashcards

1
Q

respiratory causes of chest pain?

A

pneumothorax
pneumonia
pulmonary embolus
pleurisy

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2
Q

chest pain respiratory causes - features?

A

pleuritic
fever, productive cough
sudden onset
breathless

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3
Q

gastrointestinal causes of chest pain

A

oesophageal reflux
peptic ulcer
pancreatitis
gallstones

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4
Q

chest pain gi causes - features?

A

relationship to eating
epigastric pain
indigestion, heartburn
worse lying down

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5
Q

MSK causes of chest pain?

A

muscle strain
rib fracture
costochondritis
myositis

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6
Q

chest pain MSK causes - features?

A

provoking event
worse with movement
worse with breathing
tender points

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7
Q

neurological causes of chest pain?

A

neuropathic pain
shingles
anxiety

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8
Q

chest pain neurological causes - features

A

related psychiatric symptoms
follows dermatomal pattern
recurrent admissions, previous exclusion of underlying pathology

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9
Q

cardiovascular causes of chest pain

A

ischaemic heart disease
pericarditis
aortic dissection
myocarditis (not going into detail so prob irrelevant)

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10
Q

ischaemic heart disease - different clinical presentations?

A

stable angina
unstable angina
acute myocardial infarction

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11
Q

what is angina?

A

mis-match between oxygen supply and delivery

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12
Q

angina features

A

exertional pain/tightness/discomfort,
central chest, can radiate to throat/arm/back
relieved by rest, GTN sublingual spray
worse in cold/walking into wind

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13
Q

how can GTN help diagnose angina

A

tell patient to use GTN for a week or two - if pain is relieved then could be angina

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14
Q

investigations for angina

A

blood tests
12 lead ECG

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15
Q

type of blood tests for angina and why?

A

full blood count - excludes anaemia
urea and electrolytes - normal renal
lipids - risk factor
glucose & haemoglobin A1c - diabetes

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16
Q

first line diagnostic investigation for angina?

A

CT coronary angiography (not sure if this is right?)

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17
Q

alternatives to CT coronary angiography

A

exercise tolerance test
pharmacological stress

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17
Q

alternatives to CT coronary angiography

A

exercise tolerance test
pharmacological stress with imaging

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18
Q

what drugs are given in a pharmacological stress with imaging test

A

adenosine/dobutamine - something that stimulates the heart

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19
Q

pharmacological stress with imaging - types of scans

A

radionucleotide myocardial perfusion scan
echocardiography
cardiac MRI

20
Q

calcification?

A

hardening of the arteries, often occurs at the site of narrowing

21
Q

angina lifestyle management?

A

stop smoking
weight loss
exercise
diet

22
Q

angina management - drug therapy?

A

sup lingual GTN spray
aspirin
beta-blockers
calcium channel antagonists
atorvastatin
ACE inhibitor

23
Q

sub lingual GTN spray function? (angina)

A

symptomatic relief during anginal episode

24
Q

aspirin function? (angina)

A

antiplatelet

25
Q

beta-blockers function? (angina)

A

slows heart rate, reduced myocardial O2 demands

26
Q

calcium channel antagonists function? (angina)

A

coronary vasodilator

27
Q

atorvastatin function? (angina)

A

reduces cholesterol

28
Q

ACE inhibitor function? (angina)

A

treat blood pressure

29
Q

CVD risk factors

A

age, family history, blood pressure, cholesterol, diabetes, smoking, diet

30
Q

acute coronary syndrome (unstable angina) features - chest pain?

A

gradual or sudden onset
crushing/weight/tightness
radiate to neck/jaw/arms
lasts over 15 mins

31
Q

acute coronary syndrome symptoms other than chest pain

A

nausea, vomiting, sweating, breathlessness

32
Q

what should be done within 10 minutes arrival of a patient presenting with unstable angina?

A

12 lead ECG

33
Q

investigation for unstable angina other than ECG? what does this indicate?

A

serum highly-sensitive troponin (indicates myocardial necrosis)

34
Q

12 lead ECG for unstable angina features?

A

ST segment changes:
ST elevated MI (STEMI)
non ST elevated MI (NSTEMI)

35
Q

what does each ECG letter represent

A

P - atrial contraction
QRS - ventricular contraction
T & U - repolarization

36
Q

what is ST elevation?

A

elevation of the segment on an ECG between S and T.

37
Q

what feature is present on an ECG weeks after a STEMI?

A

pathological Q wave (wider/deeper)

38
Q

what occurs in a NSTEMI?

A

ST wave becomes depressed, can develop into inversion

39
Q

what type makes up the majority of heart attacks?

A

NSTEMIs
(80%)

40
Q

pathophysiological difference between NSTEMI and STEMI

A

STEMI - complete occlusion of coronary artery
NSTEMI - threatened occlusion but not complete

41
Q

acute management of NSTEMI/STEMI

A

pain relief with morphine/opiate
start oral aspirin and clopidogrel
parental anticoagulation
oral or iv betablocker

42
Q

parental anticoagulation?

A

heparin, LMWH, factor Xa inhibitor

43
Q

secondary prevention of future MI/strokes/death?

A

aspirin/clopidogrel
beta-blocker
ACE inhibitor/ARB (angiotensin receptor blocker)
high dose atorvastatin
treat diabetes if present
lifestyle advice

44
Q

pericarditis presentation - ECG

A

can look like a heart attack.
small amount of ST elevation
PR depression

45
Q

aortic dissection - who does it occur in?

A

those with high blood pressure (mechanical tearing of lining)
Marfan syndrome

46
Q

aortic dissection presentation?

A

severe, tearing, centre of chest through back between shoulder blades
asymmetrical pulses

47
Q

diagnostic test for aortic dissection

A

CT scan chest with contrast (shows black line through aorta)

KCP - sem 2 (10 decks)

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