CVS - Chest pain/ACS

Question 1

What is the difference between visceral and somatic sounding pain?

Answer 1

Visceral - poorly localised - dull

Somatic - sharp, often well localised - worse e.g. with inspiration

Question 2

What are clinical signs/symptoms of pericarditis?

Answer 2

• Retrosternal sharp chest pain
• Worse lying flat or with inspiration
• May hear pericardial rub on auscultation

Question 3

How can you tell pericarditis on ECG?

Answer 3

Widespread saddle shaped ST elevation on ECG

Question 4

Why does pain only occur on exercise with angina?

Answer 4

Because heart tissue ischaemia only occurs when metabolic demands of cardiac muscle are greater than what can be delivered via coronary arteries

Question 5

What is ACS and what diseases does it include?

Answer 5

Acute myocardial ischaemia caused by atherosclerotic coronary artery disease.

Includes unstable angina, myocardial infarction, NSTEMI, STEMI

Question 6

What is the problem with troponin test? What is the specificity like for troponin test?

Answer 6

Troponin can be increased in things other than MI e.g. infections, HF, myocarditis, PE, pulm HTN, COPD exacerbation etc. So doesn’t have that high specificity

Question 7

What occurs to an athertoslerotic plaque to cause ACS?

Answer 7

Rupture of plaque 
Platelet aggregation 
Clotting cascade
Thrombus 
Partially or fully occluded

Question 8

How do you test to differentiate unstable angina vs NTEMI/STEMI?

Answer 8

Troponin test - Troponin not leaked in unstable angina

Question 9

What will a clinical examination often look like with stable angina?

Answer 9

Normal

Question 10

What kinds of medications might you have for angina?

Answer 10

B blockers
GTN 
Aspirin
Ca channel blockers
Statins