Chest Pain Workshop

Question 1

Which ECG leads relate to which part of the heart, and which coronary artery/branch relates to these?

Answer 1

2, 3, avF = inferior = RCA

1, avL, v5 and v6 = Lateral = Circumflex

v4 and v5 = anterior = RCA

v1 and v2 = septal = Left Anterior Descending

Question 2

What may a chest X-ray show in an MI?

Answer 2

Pulmonary oedema

Question 3

Why may BM be high in an MI?

Answer 3

As part of the stress response

Question 4

What may an art blood gas show in the event of an MI?

Answer 4

Resp alkalosis due to hyperventilation

Hyperventilation is due to feeling breathless due to pulmonary oedema caused by MI

Question 5

What information can a FAST scan give you in the even of an MI?

Answer 5

It can give you an ejection fraction and pick up any regions of dyskinesia (arrhythmic due to ischaemic) tissue

Ejection fraction may be reduced <55% in an MI as a result

Question 6

Name some anti-platelet drugs.

Answer 6

Aspirin
Clopidogrel
Ticagrelor

Question 7

How does aspirin work to inhibit platelet function?

Answer 7

It’s a non-selective COX inhibitor, which are enzymes involved in prostaglandin and therefore thromboxane A2 synthesis.

Thromboxane A2 (produced by active platelets) is important in stimulating new platelets and increasing their aggregation in thrombosis

Question 8

How does clopidogrel work to inhibit platelet function?

Answer 8

Prodrug

It is metabolised to active form which inhibits p2y12 subtype of ADP receptors found on platelet surfaces, and are important in platelet activation and fibrin cross linking