CT 1 - Chest pain Flashcards
what things could lead to an elevation in troponin (indicator of heart muscle damage)
- ischaemic heart disease, MI
- PE
- Inflammation eg pericarditis and myocarditis
- haemodynamic strain in aortic dissection, sepsis, blood loss, burns etc
- very fast heart rates, AF, SVT
- strain within the heart such as aortic stenosis or HOCM
- ballooning eg takotsubo’s
- trauma
what is the likely mechanism of loss of blood supply to the heart
- most commonly = thrombus formation (atherosclerosis)
- coronary artery spasm
- spontaneous coronary artery dissection
what is the acute treatment if we suspect a blocked CA
- dual anti-platelet therapy (ticagrelor + aspirin)
- anticoagulant
- undergo angiogram
- secondary prevention initiated (BB, ACEi and statin)
- maybe echo to check if there was significant enough damage to muscle to impair function
STEMI indicates what
complete blockage of coronary artery
NSTEMI indicates what
partial blockage of CA
what are MSK causes of chest pain
costochondritis
rib fractures
muscle strain
fibromyalgia
what are pleuritic causes of chest pain
- pneumonia
- PE
- pneumothorax
- pleuritis
what is pleuritic chest pain
sharp stabbing pain worsened by inspiration or coughing
what are causes of oesophageal chest pain
GORD
oesophageal spasm
oesophagitis
characteristics of pericardial pain and causes
sharp pain worsened by lying flat and relieved by sitting up/leaning forward
pericarditis
pericardial effusion
cardiac causes of chest pain
angina
ACS
MI
how to recognise MI
o Prolonged (>20 min) crushing chest pain.
o Radiation to the arm, jaw, or neck.
o Associated symptoms: Dyspnoea, sweating, nausea, syncope.
o Not relieved by rest or nitro-glycerine.
what are the key investigations for MI
- ECG (ST elevations in 2 or more leads) STEMI
NSTEMI - ST depression or T wave inversions
- cardiac biomarkers: troponin I or T
Elevated within 3-4 hours, peaks at 24 hours, remains elevated for up to 10 days. - echo
- angiography
what are non MI causes of elevated troponin
myocarditis, pulmonary embolism, sepsis, renal failure, and heart failure.
how to differentiate between stable angina and ACS
ACS- umbrella term covering unstable angina, NSTEMI and STEMI
SA is relieved by rest but ACS still occurs on rest
SA shouldnt last longer than 10 mins and ACS >20 mins
SA= normal ECG
SA = troponin normal
treatment approach for NSTEMI + STEMI
- STEMI: Immediate PCI (Percutaneous Coronary Intervention) within 90 minutes or thrombolysis if PCI is unavailable.
- NSTEMI: Early risk assessment for angiography and PCI.
Acute Myocardial Infarction (AMI) Patient Pathway
- Prehospital: Rapid EMS activation, aspirin administration.
- Hospital: Emergency department triage, ECG within 10 minutes, reperfusion therapy.
- Post-PCI care: Monitoring for complications, secondary prevention (antiplatelets, beta-blockers, statins).
- Barriers to rapid diagnosis:
o Atypical symptoms (e.g., in women, elderly, diabetics).
o Delayed presentation.
management of stable angina
- Lifestyle Modifications: Smoking cessation, diet, exercise.
- Medications:
o Nitrates (symptom relief).
o Beta-blockers/CCBs (reduce myocardial oxygen demand).
o Aspirin, statins (secondary prevention).
Role of Cardiac Rehabilitation
- Phases:
1. Acute phase: Education, risk factor management.
2. Subacute phase: Supervised exercise.
3. Long-term: Lifestyle modifications, medication adherence. - Benefits:
o Reduces mortality and recurrent MI risk.
o Improves exercise capacity and quality of life
Ethnic & Gender Differences in Ischemic Heart Disease
- Ethnic Differences:
o South Asians: Higher MI risk due to metabolic syndrome.
o Black populations: More hypertension-related heart disease. - Gender Differences:
o Women present with atypical symptoms.
o Under-recognition leads to treatment delays.
How much (blood) does the heart pump out every minute?
How much (blood) do the coronary arteries receive every minute?
1) CO = HR X SV
= 5 Litres per min
2) Coronary arteries receive 5% of CO so about 250mLs per min
