Clinical Demo Flashcards
What are visceral causes of chest pain?
- Cardiac
- Pulmonary
- GI
What are somatic causes of chest pain?
- Musculoskeletal - chest injury
- Spinal - cervical + thoracic
What are the mediators of cardiac ischaemic pain?
- Hypoxia activates presso + chemo receptors
- Pain producing substances: lactic acid, K+, kinins, adenosine
- Distension of cardiac chambers
Describe visceral pain
- Deep
- Discomfort, pressure tightness, squeezing, dull, aching
- Poorly localised
- Sense of malaise
- Strong autonomic reflexes e.g. sweating, nausea, dizziness
Describe referred pain
- Superficial
- Numbness, tingling, aching
- Localised to dermatomes
What can increase myocardial oxygen demand?
Exercise Emotional stress Peripheral vasoconstriction Ventricular hypertrophy Thyrotoxicosis
What can decrease myocardial oxygen supply?
Coronary atheroma Coronary spam Microvascular dysfunction Anaemia Blood redistribution
How can increased myocardial O2 demand be met?
Only by increasing blood flow + O2 delivery
What physiology can reduce coronary blood flow
- Epicardial narrowing
- Microvascular (endothelial dysfunction)
What is the innervation of the pericardium?
- Sensation from parietal layer
- Phrenic nerve
- Pain can be visceral and referred
- Pleura more sensitive then pericardium
What causes pericarditis?
Inflam of pericardium > activate afferent pain fibres
Inflam = friction = pericardial effusion
What is the main cause of acute idiopathic pericarditis?
Viral
Often with myocarditis
Flu like symptoms
What is aortic dissection?
Inner layer of aorta tears = blood causes inner + middle layers of aorta to separate
What are the symptoms of aortic dissection?
Severe pain, nausea, vomiting, sweating, fainting, hiccups
What is the management of aortic dissection?
- Treat hypertension - IV blockers, Na nitroprusside
- Treat severe chest pain
- Emergency cardiac surgery
