MedEd Cardio 1 Cases Flashcards
Definition of angina
Angina pectoris is CP from heart due to myocardial ischaemia, brought on by exertion, relieved by rest
Pathophysiology of angina
atherosclerotic processed in coronary artery disease
Rare causes: anaemia, tachyarrhythmia, HF, small vessel disease
Types of angina
Decubitus Angina - symptoms when lying down
Printzmetal Angina - symptoms caused by coronary artery vasospasm
Unstable Angina - symptoms on rest or of increasing frequency/severity
Syndrome X - symptoms of angina but with normal ETT and normal coronary angiograms (X-ray)
Presentation of ACS/Angina
S – central
O – sudden
C – crushing, tight
R – left arm, jaw
A – sweating, nausea, collapse, SOB, pallor
T – at rest (ACS)
E – exacerbated by exercise, cold weather, emotion, relieved by GTN
O/E of angina
Signs
pallor, sweaty, anxious
Signs - xanthelasma, corneal arcus
Rx of ACS/Angina
NB ACS = STEMI/NSTEMI/unstable angina
Non Modifiable – age, male, Fhx of IHD (MI in 1st Degree relative <55)
Modifiable – smoking, HTN, DM, hyperlipidaemia, obesity, cocaine
How to diagnose angina pain
Constricting discomfort in the chest, or neck, shoulders, jaw, arms
Precipitated by exercise
Relieved by rest or GTN within 5 minutes
Clinical assessment: 3 above features = typical angina
2 = atypical angina
1 or none = non-anginal pain
ECG: ST shortening/inversion, pathological Q waves, or normal ECG
Ix for angina
….. see notes
Mx for angina
Conservative Mx =
smoking cessation, weight loss, exercise
Medical Tx =
Anti-Anginals – BB/CCB
Preventative/Episodic Tx – GTN (warn patients to call ambulance if no relief 5 mins after 2nd dose)
RF Mx – aspirin, ACEi, BB
Surgical Tx= If Medical Tx insufficient consider PCI or CABG
A 75 year old male with known colorectal carcinoma presents to A&E with chest pain and shortness of breath. The pain is worse on breathing in and coughing. What other sign/symptom would aid your diagnosis?
- Gradual onset chest pain
- Absent peripheral pulses
- Collapsing Pulse
- Haemoptysis
- Abdominal Pain
Haemoptysis
Mr B a 52 year old male presents to his GP with central, tight chest pain. He has noticed the pain comes on when he is gardening or walking to the bus stop in a hurry, but normally goes away when he rests. What medication would the GP prescribe to treat his underlying condition?
- GTN spray
- Propanolol (Beta Blocker)
- Ramipril (ACEi)
- Aspirin
- Atorvastatin (Statin)
Propanolol
treat UNDERLYING angina pectoris - slows HR, decreases BP
A 70 year old gentleman with known hypertension presents to A&E with tearing chest pain, radiating to the back. His CXR shows a widened mediastinum. What is the most likely diagnosis?
- Aortic Dissection
- STEMI
- Teitze’s Syndrome
- Costochondritis
- Pulmonary Embolism
Aortic Dissection
A 54 year old gentleman with a BMI of 27kg/m2 presents with burning chest pain. He finds that it is often worse in the evening and has noted a strange taste in his mouth. What is the most likely diagnosis?
- Angina
- Teitze’s Syndrome
- Aortic Dissection
- GORD
- Pericarditis
GORD
A 60 year old patient presents to A&E with central crushing chest pain, radiating to the jaw. His ECG is normal. What is the next step?
- Creatine Kinase
- Repeat ECG
- Discharge
- Exercise ECG
- Troponin
troponin
see if NSTEMI - which can have normal ECG
A 46 year old diabetic man presents to A&E following collapse. The patient is very distressed and is sweating. On the way to the hospital, his wife had to stop the car to allow him to vomit. His ECG is normal but his 12 hour troponins are positive. What is the most likely diagnosis?
- Inferior STEMI
- Anterior STEMI
- NSTEMI
- Unstable Angina
- Ventricular Wall Aneurysm
NSTEMI
A 68 year old patient presents to A&E with sharp central chest pain. She was discharged 4 weeks ago following an MI. Her ECG shows saddle-shaped ST segments diffusely. What is the most likely diagnosis?
- Repeat MI
- Dressler’s Syndrome
- Pericarditis
- Ventricular Wall Aneurysm
- Heart Failure
Dressler’s syndrome
A 56 year old overweight man with a history of high cholesterol comes in complaining of central crushing chest pain that came on at rest. He has had a similar pain before but only when playing tennis. His ECG shows ST depression and a 12 hour troponin is negative.
- Inferior STEMI
- Anterior STEMI
- NSTEMI
- Unstable Angina
- Ventricular Wall Aneurysm
Unstable Angina
A 50 year old man presents to his GP with central chest pain. The ECG shows a STEMI. His sats are 96%. What medication should the GP give whilst waiting for an ambulance?
- Fondaparinux 2.5mg
- Oxygen
- Propanolol
- Aspirin/Clopidogrel 300mg
- Ramipril
Aspirin/Clopidogrel 300mg
as STEMI
A 70 year old female with known hypertension and hypercholesterolaemia presents with central crushing chest pain, which radiates to the left arm. The pain started 2 hours ago. Her ECG shows LBBB. What is the most appropriate management?
- Thrombolysis
- Angiography
- Fibrinolysis
- PCI
- CABG
- Fondaparinux
PCI
acute onset LBB -> STEMI
A 78 year old woman is bought to A&E following chest pain. Her ECG shows ST depression and T-wave inversion. 12 hour troponins are positive. What is the most appropriate management?
- PCI
- Fibrinolysis
- Fondaparinux
- CABG
- Thrombolysis
- Angiography
Fondaparinux
- LMWH for NSTEMI
A man is being discharged following an MI. Which of the following drugs should not make up a part of his post MI management?
- ACEi
- Aspirin
- Clopidogrel
- Heparin
- Statin
- B-Blocker
Heparin
short acting, given parenterally
