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Question 1

Give some common causes of chest pain

Answer 1

Lungs (pneumonia, pulmonary embolism, pneumothorax)GI (oesophagus – reflux, peptic ulcer disease, cholecystisis)Chest wall (costochondritis, fibrositis, skin problems)CVS (MI, angina, pericarditis, aortic dissection)

Question 2

Give some modifiable risk factors for coronary atheroma

Answer 2

ExerciseSmokingDiet – hyperlipidaemia, obesityStressHypertensionDiabetes mellitus

Question 3

Give some non-modifiable risk factors for coronary atheroma

Answer 3

Gender – males have higher risk (sucks to be you Matt :-P)Increasing ageFamily history

Question 4

What are the four main modifiable risk factors for coronary atheroma?

Answer 4

HyperlipidaemiaSmokingHypertension Diabetes mellitus (doubles risk of ischaemic heart disease)

Question 5

Describe angina

Answer 5

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

Question 6

Describe myocardial infarction

Answer 6

Coronary artery lumen is occluded (thrombus from ruptured atheroma tours plaque)Blood cannot supply cardiac muscleIschaemia occurs followed by infarction

Question 7

Give some clinical signs of angina

Answer 7

ST depression Narrowed coronary arteries appear on an angiogram

Question 8

Give some symptoms of angina

Answer 8

Central chest pain on exertion – returns to normal on resting Shortness of breath (dyspnea)Nausea, dizziness, vomitingFatigue

Question 9

Signs do myocardial infarction

Answer 9

ST elevation (may or may not be depending on if infarction is full thickness or not)High creatine kinase and troponin 1 levels

Question 10

What is a non ST elevated myocardial infaction?

Answer 10

Non- full thickness infarction

Question 11

Give some symptoms of myocardial infarction

Answer 11

Central crushing chest pain, may radiate to chest and shoulders. Is not relieved by restPallorNauseas, dizziness (can lead to syncope), vomiting

Question 12

What is unstable angina?

Answer 12

Ischaemic central chest pain which can occur at rest

Question 13

What is unstable angina caused by?

Answer 13

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

Question 14

Give some symptoms of acute pericarditis

Answer 14

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

Question 15

Give some signs of acute pericarditis

Answer 15

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

Question 16

Give some causes of acute pericarditis

Answer 16

Viral or bacterial infectionTuberculosisHIVUraemia pericarditis due to untreated kidney failureMyocardial infarction Metastasising cancers to pericardiumInflammatory disease

Question 17

Where can ischaemic chest pain be felt?

Answer 17

CentralRetrosternalLeft sided

Question 18

How can ischaemic chest pain be described?

Answer 18

TighteningHeavy CrushingConstricting PressureBurning epigastric pain for an inferior MI

Question 19

Describe an atheroma tours plaque

Answer 19

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

Question 20

When can episodes of stable angina occur?

Answer 20

ExertionEmotion especially after meals and in cold weather

Question 21

Give some treatments for acute episodes of angina

Answer 21

Sublingual nitrate spray or tablet

Question 22

Give some treatment that prevents episodes of angina

Answer 22

Beta blockersCa2+ channel blockersOral nitrates

Question 23

Give some treatments that prevents cardiac events

Answer 23

AspirinStatinsACE inhibitors

Question 24

Why does unstable angina develop?

Answer 24

Due to an increased formation of an atheromatous plaque. Eh lumen is being occluded more