deck_835133 Flashcards
Give some common causes of chest pain
Lungs (pneumonia, pulmonary embolism, pneumothorax)GI (oesophagus – reflux, peptic ulcer disease, cholecystisis)Chest wall (costochondritis, fibrositis, skin problems)CVS (MI, angina, pericarditis, aortic dissection)
Give some modifiable risk factors for coronary atheroma
ExerciseSmokingDiet – hyperlipidaemia, obesityStressHypertensionDiabetes mellitus
Give some non-modifiable risk factors for coronary atheroma
Gender – males have higher risk (sucks to be you Matt :-P)Increasing ageFamily history
What are the four main modifiable risk factors for coronary atheroma?
HyperlipidaemiaSmokingHypertension Diabetes mellitus (doubles risk of ischaemic heart disease)
Describe angina
Is caused by decreased blood supply to the myocardium– during diastole, the filling period of coronary arteries is less so there is less blood supply to the myocardium– have partially occluded/narrowed coronary arteries in anginaDemand of blood to ten myocardium is not met by the supply which causes ischaemia and chest pain
Describe myocardial infarction
Coronary artery lumen is occluded (thrombus from ruptured atheroma tours plaque)Blood cannot supply cardiac muscleIschaemia occurs followed by infarction
Give some clinical signs of angina
ST depression Narrowed coronary arteries appear on an angiogram
Give some symptoms of angina
Central chest pain on exertion – returns to normal on resting Shortness of breath (dyspnea)Nausea, dizziness, vomitingFatigue
Signs do myocardial infarction
ST elevation (may or may not be depending on if infarction is full thickness or not)High creatine kinase and troponin 1 levels
What is a non ST elevated myocardial infaction?
Non- full thickness infarction
Give some symptoms of myocardial infarction
Central crushing chest pain, may radiate to chest and shoulders. Is not relieved by restPallorNauseas, dizziness (can lead to syncope), vomiting
What is unstable angina?
Ischaemic central chest pain which can occur at rest
What is unstable angina caused by?
A transient blockage which can be due to platelet aggregation, coronary thrombosis or coronary artery spasms – due to ischaemia rather than and increase in demand for oxygen
Give some symptoms of acute pericarditis
Central stabbing chest painPain is increased by lying down or deep breathing Pain is relieved by sitting down and leaning forwardPain can be referred to the shoulders (C4 dermatome)PalpitationsShortness of breathFatigue
Give some signs of acute pericarditis
PallorFiction rub upon auscultationCan see fluid collection in pericardial sac by echo or ultrasoundMay see cardiac enlargement on an x-raySaddle-shaped ST elevations which are unrelated to the distribution of C arteries
Give some causes of acute pericarditis
Viral or bacterial infectionTuberculosisHIVUraemia pericarditis due to untreated kidney failureMyocardial infarction Metastasising cancers to pericardiumInflammatory disease
Where can ischaemic chest pain be felt?
CentralRetrosternalLeft sided
How can ischaemic chest pain be described?
TighteningHeavy CrushingConstricting PressureBurning epigastric pain for an inferior MI
Describe an atheroma tours plaque
Plaque with a necrotic centre and fibrous cap found in the coronary vessels which occludes the lumen of the artery – occurs when more than 70% f the lumen is occluded
When can episodes of stable angina occur?
ExertionEmotion especially after meals and in cold weather
Give some treatments for acute episodes of angina
Sublingual nitrate spray or tablet
Give some treatment that prevents episodes of angina
Beta blockersCa2+ channel blockersOral nitrates
Give some treatments that prevents cardiac events
AspirinStatinsACE inhibitors
Why does unstable angina develop?
Due to an increased formation of an atheromatous plaque. Eh lumen is being occluded more
