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Cardiovascular Monica xx > differential diagnosis of chest pain > Flashcards

differential diagnosis of chest pain Flashcards

1
Q

autonomic innervation

A

sympathetic nerves
=increase HR
=increase contractility

2.Parasympathetic nerves
=decrease HR

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2
Q

how does the autonomic innervation + visceral afferent nerves reach heart

A

via cardiac cariac plexus

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3
Q

visceral afferent nerves

A
  1. pain fibres travel to spinal coed alongside sympathetic nerves
  2. reflux afferents travel mainly in vagus nerve
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4
Q

sympathetic CNS—–> Organs

A 
CNS
presympathetic fibre/ preganglionic fibre
sympathetic chain ganglion
postsynaptic fibre
organ
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5
Q

parasympathetic ganglion synapse

A

acetylcholine

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6
Q

what is acetylcholine

A

neurotransmitter

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7
Q

postsympathetic fibre

A

noradrenaline

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8
Q

PREsynaptics sympathetic fibres from brain

A
  1. travel inferiorly within spinal cord

2. exit spinal cord in one of T1-L2/3 spinal nerves

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9
Q

cardiopulmonary splanchnic nerves

A

sympathetic nerves to heart + lungs

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10
Q

bilateral sympathetic intervention

A

cardiopulmonary splanchnic nerves to midline organ

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11
Q

cardiac plexus contains

A

sympathetic fibres
parasympathetic fibres
visceral afferent fibres

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12
Q

cardiopulmonary splanchnic nerves contain

A

postsympathetic fibres from cervical + upper thoracic sympathetic chains

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13
Q

parasympathetic CNS —-> Organs

A 
CNS
presynaptic fibre
parasympathetic ganglion synapse
postsynaptic fibre
organ
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14
Q

parasympathetic ganlioni

A

acetylcholine

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15
Q

parasympathetic postsynaptic fibre

A

acetylcholine

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16
Q

parasympathetic signals reach organs

A

cranial nerves 3, 7, 9 + 10

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17
Q

name CN 3

A

oculomotor nerve

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18
Q

name CN 7

A

facial nerve

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19
Q

name CN 9

A

glossopharyngeal nerve

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20
Q

name CN 10

A

vagus nerve

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21
Q

CN 10

A

presynaptic parasympathetic fibres in vagus nerve - synapse postsynaptic neurones

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22
Q

pelvic splanchnic nerves are what

A

parasympathetic

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23
Q

somatic chest pain

A 
muscular
joint
bony
intervertebral disc
(fibrous) pericardial
nerve
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24
Q

nature of somatic pain

A

sharp, stabbing + well localised

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25
visceral chest pain
heart + great vessels trachea oesophagus abdominal viscera
26
nature visceral chest pain
dull, aching, nauseating, poorly localised
27
radiating pain
``` centre if chest spreads from -upper limb -back -neck ```
28
referred pain
only felt @ site remote from area of tissue damage in chest - upper limbs - back - neck
29
acute/ chronic pain
repeated acute episodes versus chronic pain
30
where are skin mechanoreceptors stimulated
right T4 dermatome- anterior ramus specifically - AP propagated centrally - pain crosses spinal cord - sensation reached at cerebral cortex
31
APs @ postcentral gyrus of parietal lobe
bring body wall sensations into consciousness
32
APs @ precentral gyrus of frontal lobe
contractions of body wall skeletal muscle
33
sensory homuculus
area of cerebral neocortex where sensations from diff body wall structures reach consciousness
34
where do sensory APs arrive when the left side of the chest wall is touched
postcentral gyrus of right cerebral hemisphere
35
sharp central chest pain sources
herpes zoster muscle joints + bones parietal pleura + fibrous pericardium
36
herpes zoster
reactivation of dominant virus pain felt anywhere pain precedes blisters shingles in T4/5 dermatome = present central central chest pain
37
muscle, joint + bone
pectoralis major or intercostal muscle strain dislocated costochondral joint costovertebral joint inflammation slipped thoracic intervertebral disc
38
parietal pleura + fibrous pericardium
pleurisy | pericarditis
39
dull central chest pain sources
``` trachea aorta abdominal visceral oesophagus heart ```
40
mediastinum subdivision
superior inferior anterior middle posterior
41
visceral afferent APs
bilaterally to thalamus + hypothalamus then cortex
42
what do visceral afferents travel alongside
sympathetic nerves
43
where do visceral afferents not travel alongside the sympathetic nerves
@ spinal cord | enter via posterior root
44
radiating pain
actual site + radiating
45
radiating pain in somatic structure
pain travelling along affected dermatomes
46
visceral radiating = visceral in nature explain
dermatomal pattern but still dull, aching + poorly localised in nature
47
referred pain
site remote from actual area or injury of disease
48
cause of referred pain
sensory fibres from soma + afferent fibres from viscera entering spinal cord @ same level
49
define an MI
irreversible death of part of myocardium due to occlusion of arterial blood supply
50
MI types
anterior MI inferior MI anterolateral MI
51
what gives rise to arterial blood supply to epicardium + myocardium
coronary arteries + their branches
52
what do coronary arteries arrise from
right and left aortic sinuses of ascending aorta
53
where is the left coronary artery
left atrioventricular groove between pulmonary trunk + left auricle
54
where is the right coronary artery
right atrioventricular (coronary) groove
55
most common type of patter
right dominant pattern then left dominant pattern unusual extreme right dominant pattern
56
what is coronary atherosclerosis
common site of narrowing/ occlusion
57
triple vessel disease invilves
anterior inter ventricular branch PCS circumflex branch of LCA
58
how is a triple vessel disease treated
triple bypass
59
commonly used for coronary artery bypass
radial artery/ internal thoracic artery great saphenous vein internal thoracic artery graft
60
blood supply to conducting system of heart
SA nodal branch from RCA near origin (60% patients) | AV nodal branch from RCA = PIV artery origin (80%)
61
arterial blood supply of inter ventricular septum
posterior inter ventricular artery apex left + right bundle branches LAD/ anterior inter ventricular artery

Cardiovascular Monica xx (6 decks)

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