CVS Session 10- Chest Pain And IHD

Question 1

What are the three respiratory causes of chest pain?

Answer 1

Pneumothorax
Pneumonia
Pulmonary embolism

Question 2

What are the 2 GI causes of chest pain?

Answer 2

Acid reflux

Gallbladder- cholecystitis

Question 3

What are the 3 musculoskeletal causes of chest pain?

Answer 3

Fracture/trauma to ribs
Muscle pain
Bone metastases

Question 4

When does flow occur?

Answer 4

During diastole

Question 5

When does myocardial Ischaemia occur?

Answer 5

When the supply cannot meet the oxygen demand of the myocardium

Question 6

What is the most common cause of ischaemic heart disease?

Answer 6

Atheromatous coronary artery disease

Question 7

What are the 3 non-modifiable risk factors of coronary artery disease?

Answer 7

Family history
Increasing age
Gender

Question 8

What are the 4 main modifiable risk factors of coronary artery disease?

Answer 8

Diabetes
Hypertension
Hyperlipidaemia
Smoking

Question 9

Describe an Atheromatous plaque.

Answer 9

It has a necrotic centre with a fibrous cap.

Question 10

What is the result of an unstable plaque rupture?

Answer 10

It causes blood to be exposed, platelets to aggregate and fibrin to form a clot. This forms a thrombus which reduces the lumen size, decreases blood flow and causes Ischaemia.

Question 11

What is the difference between stable and unstable angina?

Answer 11

Stable angina resolves after a few minutes with rest, where as unstable angina doesn’t and occurs during rest.

Question 12

What 3 factors trigger stable angina?

Answer 12

Exercise
Cold
Meals

Question 13

Is there myocyte injury or necrosis in stable angina?

Answer 13

No

Question 14

What two factors relieve stable angina?

Answer 14

Nitrate spray

Rest

Question 15

What can be seen in the ECG of someone with stable angina:

a. At rest
b. Upon exertion

Answer 15

a. Normal ECG trace

b. ST depression

Question 16

What are the two aims of treatment of stable angina?

Answer 16

Increase blood flow

Reduce myocardial oxygen demand

Question 17

What are 3 treatments of stable angina that lower the myocardial oxygen demand? How do they do this?

Answer 17

Beta blockers- reduce the HR and contractility
Calcium channel blockers- cause peripheral vasodilatation and therefore reduce the after load
Nitrates- cause venodilation and therefore reduce the preload

Question 18

What are the 3 treatments of stable angina that increase blood flow? How do they do this?

Answer 18

Aspirin- Decrease platelet aggregation and therefore thrombus formation
Statins- reduced LDL cholesterol and therefore prevent further atherosclerosis
Revascularisation

Question 19

What is acute coronary syndrome the result of?

Answer 19

Coronary artery occlusion

Question 20

What is a STEMI?

Answer 20

A myocardial infarction with ST elevation that is the result of a complete occlusion of the coronary artery and consequent Ischaemia and myocardial necrosis.

Question 21

What is NSTEMI?

Answer 21

It is a myocardial infarction without ST elevation. It is a partial occlusion of a coronary artery that doesn’t result in myocardial necrosis.

Question 22

What is unstable angina?

Answer 22

It is a progression of stable angina because of atheroma progression, that occurs during rest.

Question 23

What are the similarities between NSTEMI and unstable angina? (2)

Answer 23

Partial occlusion of coronary artery by thrombus

ST depression

Question 24

What distinguishes between NSTEMI and unstable angina?

Answer 24

The prescence of cardiac biomarkers in the blood.

NSTEMI has troponin present, unstable angina doesn’t.

Question 25

What is an exercise stress test and when is it used?

Answer 25

It is used when stable angina is an uncertain diagnosis following a history being taken.
The patient is hooked up to an ECG machine and a blood pressure cuff.
They stand on a treadmill and there is a gradual increase in exercise until:
-the target heart rate is reached
-chest pain occurs
-other problems occur
-ECG changes occur

Question 26

What is a myocardial infarction?

Answer 26

A complete occlusion of a coronary vessel that causes an infarct/death of myocardium.

Question 27

What are signs and symptoms of an MI? (7)

Answer 27

• central crushing chest pain
• nausea
• pallor
• sweating
• vomiting
• fainting
• breathlessness

Question 28

What are the two biochemical markers that can be detected in the blood to distinguish between and NSTEMI and unstable angina?

Answer 28

Troponin 
Creatine kinase (MB)

Question 29

What is the preferred treatment for a STEMI?

Answer 29

Percutaneous coronary intervention (PCI) - blow up a balloon inside a vessel so that the plaque is compressed. Insert a meshwork to keep the vessel dilated.

Question 30

What are the two methods of Revascularisation?

Answer 30

Percutaneous coronary intervention (PCI)

Coronary artery bypass grafting (CABG)

Question 31

What are the two groups of drugs given to treat NSTEMIs and unstable angina? Give an example of each.

Answer 31

• anticoagulants - heparin

- anti-platelet agent - aspirin

Question 32

What are 5 causes of acute pericarditis?

Answer 32

• infection
• post MI/ cardiac surgery
• autoimmune
• uraemia (kidney failure)
• malignant deposits

Question 33

What are 3 symptoms of acute pericarditis?

Answer 33

• central/left sided chest pain
• sharp, worse with inspiration
• improved by leaning forwards

Question 34

What are the three cardiovascular causes of chest pain?

Answer 34

Pericarditis
Myocardium- angina, MI
Aorta- aortic dissection