KCP: Chest Pain 2 Flashcards
Electric Boogaloo
4 common respiritory causes of chest pain?
- Pulmonary Embolus
- Pneunomia
- Pneumothorax
- Pleurisy
What is Pleurisy?
Also known as pleuritis.
Inflamation of the plaura.
Presentation is sharp pain during inspiration.
5 common gastrointestinal causes of chest pain?
- Oesophageal reflux
- Peptic ulcer
- Pancreatitis
- Gallstones
- Paraesophageal hiatus hernia
Signs that chest pain is a gastrointestinal cause?
- The pain is related to eating
- Worse when lying down
- Indigestion/ heartburn
- Epigastric pain - pain or discomfort below the ribs in your upper abdomen area
4 common musculoskeletal causes of chest pain
Muscle strain
Rib fracture
Costochondritis
Myositis
Signs that chest pain has a musculoskelletal cause?
- Provoking event
- Worse with movement
- Worse with breathing
- Tender points
3 common causes of neurological chest pain
- Neuropathic pain
- Shingles
- Anxiety
Sign it could be shingles?
Follows a dermatological pattern
Sign it could be another neurological cause?
- Recurrent admissions, previous exclusion of underlying pathology
- Related psychiatric symptoms
4 commonc ardiovascular causes of chest pain
- Ischaemic heart disease
- Pericarditis
- Aortic dissection
- Myocarditis
One for silly Baz:
What do you call a mini-stroke vs mini-heart attack (always get these mixed up)
- Mini stroke - transient incheamic attack TIA
- Mini heart attack - Angina
6 Angina presentations
- A mis-match between oxygen supply and delivery
- Exertional pain/tightness/discomfort
- Location: central chest/radiate to throat/arm/back
- relieved by resting
- Relieved by sublingual glyceryl trinitrate (GTN) sublingual spray
- Often worse in cold weather/walking into the wind
4 blood tests you do with suspected angina?
- Full blood count - PO2 could be low so this is to exclude anaemia due to low heamoglobin
- Urea and electrolytes - Normal renal function
- Lipids - risk factor
- Glucose, haemoglobin A1c - to exclude Diabetes
What is low peripheral pulses – neck, arms, legs, feet - a sign of
Angina
ECG and angina?
An ECG can often miss an angina
First line diagnostic investigation for an angina?
CT coronary angiography. This is a CT of the heart and it’s arterial blood supply
This is a normal CT-Coronary angiography. What would be different if angina is indicated?
What is stenosis?
Stenosis means narrowing
Lifestyle intervention for Angina
Stop smoking
Weight loss
Exercise
Diet- Mediteranean
Drug for symptomatic relief duirng anginal episode?
Sub-lingual GTN spray.
GTN is a vasodilator
What is GTN?
glyceryl trinitrate (GTN)
What is Atorvastatin used for?
Reduces cholesterol
What are ACE inhibitors/Angiotensin receptor blockers used for?
Use to treat blood pressure
What are Calcium channel antagonists used for?
Vasodialation
How do Beta-Blockers help with an angina?
Slows the heart rate, reduced myocardial O2 demands
How does aspirin help with angina?
It is an antiplatelet
6 grug treatments for an Angina
- Sub-lingual GTN spray for symptomatic relief during an anginal episode
- Aspirin (antiplatelet)
- Beta-blockers (slows the heart rate, reduced myocardial O2 demands)
- Calcium channel antagonists (coronary vasodilator)
- Atorvastatin (reduces cholesterol)
- ACE inhibitor/Angiotensin receptor blocker (for blood pressure)
What is acute coronary syndrome?
This covers any problem form acute lack of blood supply to the heart. Covers unstable angina through to myocardial infarction
When refering to the ECG what defines a STEMI?
Definition - ST elevation in 2 contiguous leads:
≥ 2.5mm in V2-V3 in men <40 years old
≥ 2mm in V2-V3 in men ≥40 years old
≥ 1.5mm in V2-V3 in women
≥ 1mm in all other leads
Hint - V2 and V3 heart attacks for you and me
Two types of NSTEMI
- ST Depression (>0.5 mm in two anatomically contiguous leads)
- T wave inversion (in two anatomically contiguous leads)
Semester 1 recap: Troponin
Found in raises levels in the blood and is an indicator of myocardial cell death
What is percutaneous coronary intervention (PCI)?
This is a non surgical procedure that uses a catheter in order to place a small structure (stent) inside the vessels to the heart in order to keep them open
Other cause of chest pain: Pericarditis. What is it?
Inflamation of the pericardium which is the membrane surrounding the heart
What causes pericarditis?
Can be common after infections such as pneumonia or Covid.
However can also occur post myocardial infarction or cardiac surgery
Signs of pericarditis?
- Chest pain releived by sitting forward
- Can be worse when lungs are inspired
- ECG can show Widespread ST segment elevation (concave upwards) along with PR depression
However key is that they are young and not at risk of any cardiac disease
What is an aortic dissection?
Occurs when there is a dissection of blood into the wall of the aorta.
This occludes arterial branchs including coronary arteries
If it ruptures into the pericardium can cause cardiac tamponade (pressure on heart)
Who is at risk of an aortic dissection?
Young patients with a family history of aortic dissection/Marfan syndrome/Ehlers Danlos syndrome
Older patients with Hypertension
When can a Q wave be pathological?
> 40 ms (1 mm) wide
2 mm deep
25% of depth of QRS complex
Seen in leads V1-3
The key is that they are wide and deep and show in V1-3 (same as ST elevation). This occurs during myocardial infarction and persists forever, so Q wave without ST elevation can be a sign that someone has previously had a myocardial infarct
