Lecture 20- Chest Oain And Acute Coronary Syndromes Flashcards
How common is presenting chest pain?
25% of ED presentations
How do you make a diagnosis?
Investigations
History
Clinical examinations
What to consider when looking at chest pain?
Anatomy of chest and various different places the pain could be coming from
The site
Radiation
Associated symptoms
What can cause chest pain?
Lungs Pleural sac Pericardial sac Aortic dissection Bones Muscles Oesophagus
Musculoskeletal pain?
Localised and tender to toinch. Can be pointed to with fingers, sharp
Oesophageal pain?
Indigestion and acid reflux will give burning
Aortic dissection?
Aorta ripped open and oain radiates to the back. Can be fatal
Respiratory pain?
Infection eg pneumoniae
Pulmonary embolism
How to differentiate cardiac from pleuritic pain?
Cardiac will be dull, crushing, poorly localised, often worsened with exertion. May radiate to jaw, shoulder, arm etc central pain
Pleuritic will be sharp and well localised, worse on inhalation, coughing or positional movement often lateral pain
Pericarditis?
Worse when lying down. Central pain improved by leaning forward. Often secondary to viral illness. Sharp pain localised to front of chest. Pericardial rub may be heard
ECG with widespread saddle shaped st elevation
Non modifiable risk factors for ischaemic heart disease?
Being elderly
Male
Genetic
Modifiable ischaemic heart disease risk factors?
Diabetes Smoking Hypertension Dyslipidaemia Obesity Sedentary lifestyle
What is acute coronary syndrome?
Can be either unstable angina, NSTEMI or STEMI
Caused by plaque rupture which becomes a thrombus and causes arterial occlusion
Difference between ischaemia and infarction with regard to blood tests?
Infarction involves necrosis and troponin release whereas ischaemia doesn’t
Symptomatic difference between unstable and stable angina
Pain worse in unstable
Not relieved by rest
Pain may last longer
