Ischemic Chest Pain

Question 1

Description of chest pain

Answer 1

Occlusion of coronary vessels, due to plaque buildup or thrombosis, which leads to an O2 supply and demand mismatch, resulting in Lactic acid buildup and chest pain.

Question 2

Transmural

Answer 2

Full thickness infarct

Question 3

Partial

Answer 3

Not full thickness

Question 4

Epicardium

Aka?

Answer 4

outermost wall of the myocardium.

Aka visceral pericardium as it forms the inner layer of pericardium.

Question 5

Endocardium

What is it
Cells are like
What does it do

Answer 5

Innermost wall of heart.

Similar cell structure to endothelial cells.

Provide protection to valves and heart chambers.

Question 6

Pericardium

Answer 6

the membrane enclosing the heart

Question 7

Treatment aim for Chest pain

Cardiac CP, Non STEMI, STEMI

Answer 7

Treatment with vasodilators - GTN to open the coronary arteries and restore blood supply. the aim is to reduce chest pain and transport for further investigation and/or PCI

GTN 400 microg

ASPIRIN 300mg

O2 if SpO2<94%

Unresolved pain - Clinical support for IV Fent or morph

If unavailable - consult.

Transport to PCI

Question 8

When can O2 be given in Chest pain

Answer 8

supplemental oxygen to SpO2 >94% - if Pt is showing signs of hypoxaemia, Shock or SOB

Question 9

GTN in Chest pain

Dose

Precautions

BP

Answer 9

GTN 400mcg/ spray every 5 minutes (BP Every 3) to relieve pain.

Check no PDE-5 inhibitors in (sildenafil, vardenafil, oravanafil, 24 hrs or tadalafil in 48hrs

GTN can lower BP - Pts must have an ADEQUATE BLOOD PRESSURE

Question 10

If signs of CARDIOGENIC SHOCK in Chest pain GL

1. Signs (3)
2. Treatment (4)

Answer 10

Cardiac Chest pain AND
Ischemic ECG Changes AND
Hypotension - SBP < 90mmHg

Request immediate clinical support
IV access x 2
Consider posture and prepare for deterioration
Prompt transport and notify via GRN

Question 11

If NO SIGNS of cardiogenic shock

Clinical features that must be met (3)

Tx (2)

Answer 11

Adequate blood pressure
Rate and rhythm are appropriate
No use use of PDE 5 inhibitors (sildenafil, Vardenafil, oravanafil in 24 hrs) or Tadalafil in 48 hrs

Aspirin 300mg ORAL - if appropriate
GTN 400microg SL

Question 12

In CHEST PAIN cases with UNRESOLVED PAIN.

1. Clinical support for:
   - (3)
2. EOC consult for: (2)

Answer 12

1. 
Clinical Support for pain control
-Severe pain
-Stable GCS
SBP > 100mmHg

2. IV fentanyl 25 microg - slow push every 5 min to a MAX 300microg OR
   IV morphine 25 mg - slow push every 5 mins to a max 30mg
   *Morphine caution in >65 years

Question 13

If STEMI criteria are met in CHEST PAIN

Answer 13

Request clinical support

Activate STEMI by phone

Notify receiving facility

Question 14

STEMI CRITERIA

1. ST elev:
2. When not to call a STEMI?

Answer 14

1. ST elevation of:
   - 1mm in 2 or more contiguous limb leads and/ or
   - 2mm or more in 2 or more chest leads and/ or
   - RBBB
2. Cannot call a STEMI with a LBBB