CLINICAL: Chest Pain Patient

Question 1

What is the cause of angina pectoris

Answer 1

Coronary stenosis

Question 2

What might a stress ecg show?

Answer 2

Depressed ST segment which is representative of subendocardial ischaemia

(why?? idk)

Question 3

What drugs may you use to treat myocardial ischaemia?

Answer 3

Nitrates- more NO, more vasodilation

Beta blockers: reduce heart rate and systolic blood pressure (typically B1). (lower heart rate means longer time for diastole (this is when the coronary vessels are engorged with blood)

Question 4

What preventative drugs are given to people follwoing a heart attack?

Answer 4

anti thrombolitic drugs
eg aspirin, warfarin (heparin)

and statins (lower LDL cholesterol)

Question 5

What does ST elevation show?

Deeper Q wave

Answer 5

Transmural myocardial ischaemia

More heart muscle has died with a deeper Q wave

Question 6

What drug would dissolve a clot?

Answer 6

tissue plasminogen activator (if clot has been present for a longer time)

Question 7

What is the pathology of stable vs unstable angina

Answer 7

stable angina is where at rest, no pain is felt however during exercise, due to narrowing by a plaque, the demand is to high, i.e. oredicted onset at exercise

Unstable is when the plaque is damged, blood comes in to contact with the lipid in the plaque, and a thrombus forms. Occlusion

Question 8

If heart muscle is injured, what can be elevated in serum?

Answer 8

Troponin (diagnostic for MI)

Question 9

What are the two types of MI?

Answer 9

Type 1- coronary related event
Type 2- MI due to mismatch of supply and demand (infection, anaemia, post surgery)

ECG- ST elevation vs non ST elevation

Question 10

What is characteristic of pericarditis on an ECG?

Answer 10

elevated ST segment on all leads (no reciprocal raise like in Myocardial ischaemia)

NB no q waves??? unsure