MedEd - Chest pain Flashcards
decubitus angina
symptoms occur when lying down
prinzmetal angina
symptoms caused by coronary vasospasm
coronary syndrome x
symptoms of angina but with normal exercise tolerance and normal coronary angiograms
conservative stable angina treatment
stop smoking
lose weight
exercise
medical treatment for angina
anti-anginals (BB/CCB)
symptomatic (GTN spray)
risk factor reduction (aspirin/statins/ACEi)
ACS (3)
STEMI
NSTEMI
Unstable angina
Differences between ACS types
STEMI/NSTEMI -
Unstable angina pectoris - chest pain at rest due to ischaemia without cardiac injury
BUT on presentation they all seem the same.
Who may not get ACS symptoms?
Elderly
Diabetic
Women
Investigations for ACS
ECG - STEMI - hyperacute T waves,, ST elevation, new-onset LBBB. UAP/NSTEMI - ST depression, T wave inversion
Which artery supplied AV node
Right coronary artery - so you get complete heart block
General ACS management
MONABAS(H) morphine oxygen nitrates antiplatelets (aspirin AND clopidogrel) HOME: beta-blockers ACE inhibitors statins
aim of STEMI treatment
PCI
fibrinolysis
–> coronary reperfusion
NSTEMI/UAP management
immediate -
aspirin
fondaparinux - because you are causing turbulent flow
UFH -
Clopidogrel?
P2Y12 inhibitor of ADP receptor
complications of ACS
DARTH VADER death arrhythmia rupture tamponate heart failure valve disease aneurists dressler's embolism
anticoagulants vs antiplatelets
venous (e.g.DVT, PE) - usually stasiss so activation of coagulation factors so ANTICOAGULANTS arterial thrombosis (e.g. MI, stroke) - mostly caused by vessel wall injury so ANTIPLATELETS
warfarin and ACS?
Do not use because it initally is PRO-THROMBOTIC
pericarditis
inflammation of pericardium
causes of pericarditis
idiopathic
Infective (e.g. Coxsackie B - common in young chest pain)
Connective tissue disease (e.g. sarcoidosis )
Dressler syndrome - (pericarditis that happens 2-10 weeks after MI)
Malignancy
Dressler syndrome
pericarditis 2-10weeks after MI
antibodies against cardiomyocyte antigens against which they should not have been exposed to in the first place - AUTOIMMUNE
symptoms
sharp, central chest pain pleuritis relieved by sitting forward fever/flu-like symptoms (if viral) pericardial pleural rub
pericarditis ECG
widespread saddle-shaped ST elevation, has a characteristic dip - NOT MI because the
Beck’s triad
CARDIAC TAMPONADE triad:
muffled heart sounds
raised JVP
low BP
AF causes
pneumonia PE hyperthyroid IHD alcohol pericarditis
AF symptoms
palpitations
syncope
symptoms of underlying causes
irregularly irregular pulse
AF ECG
absent P-waves
irregularly irregular
DC cardioversion vs defibrillation
DC cardioversion - monitors electric conduction of heart and delivers shock at a specific time
defibrillation - random shock that is hoped to re
AF management
rhythm control - <48hrs since onset of AF: DC cardioversion, or chemical cardioversion (flecainide [contraindicated in IHD] or amiodarone). If >48hrs then anticoag for 3-4weeks beforecardioversion
stroke risk stratification - CHADSVASC score used
rate control - verapamil, digoxin, beta-blockers
supraventricular cardioversion
regular, narrow complex tachycardia with no p waves and a supraventricular origin
symptoms: palpitations, syncope, dyspnoea, chest discomfort
types of SVT
AVRT
AVNRT
Investigations for SVT
during tachy - regular,
AVRT ECG
“delta wave” - slurred upstroke of QRS complex
SVT treatment
- Are they haemodynamically stable?
NO - synchronised DC
YES - step 2 - Vagal maneouvres - e.g. Valsalva, cold water if they work stop, if not …
- .Adenosine 6mg - warn patients because it stops your heart for a while
- Adenosine 12mg
Who do you not use adenosine in ?
asthmatics
Use ramipril instead
syncope definition
hypoperfusion to the brain causing LOC
differential diagnosis of syncope
vasovagal - increased vagal discharge causing a drop in BP and HR. Can be percipitated by situations . May feel sweaty/pale before collapse
arrhythmia - can lead to low-output state; palpitations before collapse
outflow obstruction
postural hypotension
HOCM features (4)
jerky carotid pulse
double apex beat
ejection systolic murmur
FH
syncopal and non-syncopal causes of fainting
Syncopal - vertebrobasillar insufficiency, subclavian steal syndrome, aortic dissection
Non-syncopal - intoxicatoin , head trauma, metabolic, epileptic seizures
