Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CVS > Lecture 17 > Flashcards

Lecture 17 Flashcards

1
Q

What does chest pain signify?

A

There is a spectrum (life-threatening > non-urgent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you come to a diagnosis?

A
  • history
  • clinical examination
  • investigations (ECG, blood tests- FBC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some causes of chest pain?

A

Split into categories
Respiratory: pleuritic chest pain
-diseases affecting lung: cause chest pain if affects parietal pleura
(Pneumonia/pulmonary embolism: lung tissue infarcts and inflames irritating pleura)

MSK

  • broken rib (point tenderness, breathing in/cough makes it painful = can be described as pleuritic pain= sharp)
  • costochondritis (inflammation of costal chonditis)
  • muscle spasms

Cardiac

  • MI/angina (related to coronary arteries: heart becomes ischaemic)
  • pericarditis (sharp pain, localised, made worse on breathing in/coughing= pleuritic pain, non-ischaemic)

Gastro-intestinal
-oesophagus (reflux-burning up middle of chest, made worse after eating/flat in bed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms with pneumonia/chest infection:

Ask this to determine if there is a respiratory cause for their chest pain

A
  • short of breath
  • coughing up sputum
  • fever

-check for DVT if pulmonary embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the nervous system involved in cardiac pain?

A

Pain carried through visceral nervous system: autonomic

Cardiac muscles in pain- due to coronary arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the nervous system involved in pleuritic pain?

A

Pain carried from somatic nervous system

Pain due ti irritation to parietal pleura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is visceral pain described as?

A
  • dull
  • poorly localised
  • centre of chest
  • worsened with exertion
  • may radiate to shoulder/jaw
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is pleuritic chest pain described?

A

-sharp
-well localised
-worsened by inspiration/coughing/positional movement
(Pericarditis/MSK disorders mimic pleuritic chest pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is ischameia?

A

Restriction of blood supply to tissues causing a shortage in oxygen needed for cellular metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is pericarditis?

A

Inflammation of pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In who is pericarditis more common?

A

Men and adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is pericarditis caused by?

A

Viral infection (e.g. any recent coughs/cold)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What may be heard on auscultation in a person with pericarditis?

A 
Pericardial rub (normal lub-dub, but can hear a rustling noise on top of it)
-heart rubs against inflamed layer of pericardium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is the chest pain eased/aggravated in pericarditis?

A

Eased: sitting up/leaning forward
Aggravated: inspiration/cough/lying flat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the pain the patient would feel in pericarditis:

A

Sharp, localised to the front of chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What on an ECG signifies pericarditis?

A

ST elevation, widespread, saddle shaped: all leads

Wouldn’t see this in MI: only in region affected by infarct

17
Q

Difference between unstable angina and stable angina?

A

Unstable: chest pain at rest
Stable: chest pain upon exertion

18
Q

What is ischaemic heart disease/disease of coronary arteries (encompasses angina/MI) caused by?

A

Atherosclerosis

  • fatty deposits in arteries followed by a fibrous plaque over it
  • cause occlusion
  • plaque can rupture
19
Q

What are the modifiable/non-modifiable risk factors for atherosclerosis?

A 
Same therefore as for ischaemic heart disease
Modifiable:
-smoking
-hypertension
-diabetes type 2
-obesity
-sedentary lifestyle
-dyslipidaemia (high amounts of lipids in blood)

Non-modifiable

  • advanced age
  • family history
  • male sex
20
Q

What occurs in stable angina?

A

Narrowing of arteries by stable atherosclerotic plaque: fixed occlusion

  • heart tissue only becomes ischaemic when metabolic demands of the cardiac muscle are greater than what can be delivered via coronary arteries (exercise)
  • relieved by rest
  • cardiac sounding chest pain
  • chest pain doesn’t last long
21
Q

What does acute coronary syndrome encompass?

A
  • unstable angina
  • NSTEMI/STEMI: MI

(Stable angina is not acute, usually chronic)

22
Q

How is stable angina different from an acute coronary syndrome?

A

ACS: are acute myocardial ischaemia caused by atherosclerotic coronary artery disease
(Something with plaque has changed causing sudden increase in occlusion of artery)
-may have history of stable angina until plaque ruptures forming a thrombus and greater occlusion
-therefore if occlusion is significant enough you may get pain at rest/necrosis of myocardial tissue

23
Q

What determines whether a person will have unstable angina/MI after atherosclerotic plaque rupture?

A

Degree of occlusion
Unstable angina:
-lumen become more narrow, causing heart tissue ischaemia
MI:
-large thrombus on plaque (can sometimes fully occlude artery)
-significant occlusion, muscle deprived leading to tissue death/infarcted

24
Q

What would you see in the blood from the myocytes in unstable angina/MI?

A

Unstable angina:
-myocytes don’t die/necrose so no cardiac enzymes leak out
MI:
-myocytes rupture and cardiac enzymes (troponin) leak from necrosed cardiac muscle cells

25
Q

What are the features of unstable angina?

A 
Similar to stable angina (occurs under exertion and relieved by GTN spray)
EXCEPT
-pain at rest 
-pain more intense 
-pain lasts longer 
Deteriorating further = MI
26
Q

What ECG changes may we see in unstable angina?

A
  • ST depression
  • T wave inversion
  • can be normal
27
Q

What would you see in blood tests for unstable angina?

A

Troponin negative

28
Q

What are the features of MI?

A

MI presents very similar to unstable angina

  • going to shoulder and jaw
  • pain at rest
  • autonomic features= nauseous/sweaty/pallor
29
Q

What is the ECG and blood tests for someone with an MI?

A

ECG
STEMI: ST elevation (don’t wait for blood test- straight to angioplasty)
NSTEMI: ST depression/T wave inversion (ischaemic)

Blood test: troponin positive

30
Q

How you you know where the MI occured?

A

Localisation determines anatomical region of the STEMI

31
Q

What is the difference between STEMI and NSTEMI in terms of thickness?

A

STEMI: full thickness of myocardium
NSTEMI: sub endocardial injury (between endocardium and myocardium)

CVS (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions