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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
Q

visceral chest pain

A

heart + great vessels
trachea
oesophagus
abdominal viscera

26
Q

nature visceral chest pain

A

dull, aching, nauseating, poorly localised

27
Q

radiating pain

A 
centre if chest
spreads from
-upper limb
-back
-neck
28
Q

referred pain

A

only felt @ site remote from area of tissue damage in chest

  • upper limbs
  • back
  • neck
29
Q

acute/ chronic pain

A

repeated acute episodes versus chronic pain

30
Q

where are skin mechanoreceptors stimulated

A

right T4 dermatome- anterior ramus specifically

  • AP propagated centrally
  • pain crosses spinal cord
  • sensation reached at cerebral cortex
31
Q

APs @ postcentral gyrus of parietal lobe

A

bring body wall sensations into consciousness

32
Q

APs @ precentral gyrus of frontal lobe

A

contractions of body wall skeletal muscle

33
Q

sensory homuculus

A

area of cerebral neocortex where sensations from diff body wall structures reach consciousness

34
Q

where do sensory APs arrive when the left side of the chest wall is touched

A

postcentral gyrus of right cerebral hemisphere

35
Q

sharp central chest pain sources

A

herpes zoster
muscle joints + bones
parietal pleura + fibrous pericardium

36
Q

herpes zoster

A

reactivation of dominant virus
pain felt anywhere
pain precedes blisters
shingles in T4/5 dermatome = present central central chest pain

37
Q

muscle, joint + bone

A

pectoralis major or intercostal muscle strain
dislocated costochondral joint
costovertebral joint inflammation
slipped thoracic intervertebral disc

38
Q

parietal pleura + fibrous pericardium

A

pleurisy

pericarditis

39
Q

dull central chest pain sources

A 
trachea
aorta
abdominal visceral
oesophagus
heart
40
Q

mediastinum subdivision

A

superior inferior
anterior
middle
posterior

41
Q

visceral afferent APs

A

bilaterally to thalamus + hypothalamus then cortex

42
Q

what do visceral afferents travel alongside

A

sympathetic nerves

43
Q

where do visceral afferents not travel alongside the sympathetic nerves

A

@ spinal cord

enter via posterior root

44
Q

radiating pain

A

actual site + radiating

45
Q

radiating pain in somatic structure

A

pain travelling along affected dermatomes

46
Q

visceral radiating = visceral in nature explain

A

dermatomal pattern but still dull, aching + poorly localised in nature

47
Q

referred pain

A

site remote from actual area or injury of disease

48
Q

cause of referred pain

A

sensory fibres from soma + afferent fibres from viscera entering spinal cord @ same level

49
Q

define an MI

A

irreversible death of part of myocardium due to occlusion of arterial blood supply

50
Q

MI types

A

anterior MI
inferior MI
anterolateral MI

51
Q

what gives rise to arterial blood supply to epicardium + myocardium

A

coronary arteries + their branches

52
Q

what do coronary arteries arrise from

A

right and left aortic sinuses of ascending aorta

53
Q

where is the left coronary artery

A

left atrioventricular groove between pulmonary trunk + left auricle

54
Q

where is the right coronary artery

A

right atrioventricular (coronary) groove

55
Q

most common type of patter

A

right dominant pattern
then left dominant pattern
unusual extreme right dominant pattern

56
Q

what is coronary atherosclerosis

A

common site of narrowing/ occlusion

57
Q

triple vessel disease invilves

A

anterior inter ventricular branch
PCS
circumflex branch of LCA

58
Q

how is a triple vessel disease treated

A

triple bypass

59
Q

commonly used for coronary artery bypass

A

radial artery/ internal thoracic artery
great saphenous vein
internal thoracic artery graft

60
Q

blood supply to conducting system of heart

A

SA nodal branch from RCA near origin (60% patients)

AV nodal branch from RCA = PIV artery origin (80%)

61
Q

arterial blood supply of inter ventricular septum

A

posterior inter ventricular artery
apex
left + right bundle branches
LAD/ anterior inter ventricular artery

Cardiovascular Monica xx (6 decks)

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