differential diagnosis of chest pain Flashcards
autonomic innervation
sympathetic nerves
=increase HR
=increase contractility
2.Parasympathetic nerves
=decrease HR
how does the autonomic innervation + visceral afferent nerves reach heart
via cardiac cariac plexus
visceral afferent nerves
- pain fibres travel to spinal coed alongside sympathetic nerves
- reflux afferents travel mainly in vagus nerve
sympathetic CNS—–> Organs
CNS presympathetic fibre/ preganglionic fibre sympathetic chain ganglion postsynaptic fibre organ
parasympathetic ganglion synapse
acetylcholine
what is acetylcholine
neurotransmitter
postsympathetic fibre
noradrenaline
PREsynaptics sympathetic fibres from brain
- travel inferiorly within spinal cord
2. exit spinal cord in one of T1-L2/3 spinal nerves
cardiopulmonary splanchnic nerves
sympathetic nerves to heart + lungs
bilateral sympathetic intervention
cardiopulmonary splanchnic nerves to midline organ
cardiac plexus contains
sympathetic fibres
parasympathetic fibres
visceral afferent fibres
cardiopulmonary splanchnic nerves contain
postsympathetic fibres from cervical + upper thoracic sympathetic chains
parasympathetic CNS —-> Organs
CNS presynaptic fibre parasympathetic ganglion synapse postsynaptic fibre organ
parasympathetic ganlioni
acetylcholine
parasympathetic postsynaptic fibre
acetylcholine
parasympathetic signals reach organs
cranial nerves 3, 7, 9 + 10
name CN 3
oculomotor nerve
name CN 7
facial nerve
name CN 9
glossopharyngeal nerve
name CN 10
vagus nerve
CN 10
presynaptic parasympathetic fibres in vagus nerve - synapse postsynaptic neurones
pelvic splanchnic nerves are what
parasympathetic
somatic chest pain
muscular joint bony intervertebral disc (fibrous) pericardial nerve
nature of somatic pain
sharp, stabbing + well localised
visceral chest pain
heart + great vessels
trachea
oesophagus
abdominal viscera
nature visceral chest pain
dull, aching, nauseating, poorly localised
radiating pain
centre if chest spreads from -upper limb -back -neck
referred pain
only felt @ site remote from area of tissue damage in chest
- upper limbs
- back
- neck
acute/ chronic pain
repeated acute episodes versus chronic pain
where are skin mechanoreceptors stimulated
right T4 dermatome- anterior ramus specifically
- AP propagated centrally
- pain crosses spinal cord
- sensation reached at cerebral cortex
APs @ postcentral gyrus of parietal lobe
bring body wall sensations into consciousness
APs @ precentral gyrus of frontal lobe
contractions of body wall skeletal muscle
sensory homuculus
area of cerebral neocortex where sensations from diff body wall structures reach consciousness
where do sensory APs arrive when the left side of the chest wall is touched
postcentral gyrus of right cerebral hemisphere
sharp central chest pain sources
herpes zoster
muscle joints + bones
parietal pleura + fibrous pericardium
herpes zoster
reactivation of dominant virus
pain felt anywhere
pain precedes blisters
shingles in T4/5 dermatome = present central central chest pain
muscle, joint + bone
pectoralis major or intercostal muscle strain
dislocated costochondral joint
costovertebral joint inflammation
slipped thoracic intervertebral disc
parietal pleura + fibrous pericardium
pleurisy
pericarditis
dull central chest pain sources
trachea aorta abdominal visceral oesophagus heart
mediastinum subdivision
superior inferior
anterior
middle
posterior
visceral afferent APs
bilaterally to thalamus + hypothalamus then cortex
what do visceral afferents travel alongside
sympathetic nerves
where do visceral afferents not travel alongside the sympathetic nerves
@ spinal cord
enter via posterior root
radiating pain
actual site + radiating
radiating pain in somatic structure
pain travelling along affected dermatomes
visceral radiating = visceral in nature explain
dermatomal pattern but still dull, aching + poorly localised in nature
referred pain
site remote from actual area or injury of disease
cause of referred pain
sensory fibres from soma + afferent fibres from viscera entering spinal cord @ same level
define an MI
irreversible death of part of myocardium due to occlusion of arterial blood supply
MI types
anterior MI
inferior MI
anterolateral MI
what gives rise to arterial blood supply to epicardium + myocardium
coronary arteries + their branches
what do coronary arteries arrise from
right and left aortic sinuses of ascending aorta
where is the left coronary artery
left atrioventricular groove between pulmonary trunk + left auricle
where is the right coronary artery
right atrioventricular (coronary) groove
most common type of patter
right dominant pattern
then left dominant pattern
unusual extreme right dominant pattern
what is coronary atherosclerosis
common site of narrowing/ occlusion
triple vessel disease invilves
anterior inter ventricular branch
PCS
circumflex branch of LCA
how is a triple vessel disease treated
triple bypass
commonly used for coronary artery bypass
radial artery/ internal thoracic artery
great saphenous vein
internal thoracic artery graft
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%)
arterial blood supply of inter ventricular septum
posterior inter ventricular artery
apex
left + right bundle branches
LAD/ anterior inter ventricular artery
