Mr S - severe chest pain Flashcards
What are the 4 conditions coming under acute coronary syndrome
N-STEMI
STEMI
unstable angina
posterior infarcts
A young adult female with severe chest pain is likely to be suffering from (3)
- PE
- Pneumothorax (++ if tall&thin)
- Cocaine-induced coronary spasm
signs of systemic artherosclerotic vascular disease: (5)
- weak pulses
- peripheral cyanosis
- atrophic skin
- ulcers
- bruits on auscultation of carotids
signs of hypercholesterolaemia (3)
- xanothmata on bony prominences e.g. elbow
- xanthelasma around the eye
- corneal arcus (normal in elderly)
how does anaemia relate to prognosis for ischaemic heart disease?
anaemia can cause or exacerbate IHD
signs of anaemia (4)
NETL
Eyes - conjuctival pallor
Tongue -glossitis
lips - angular stomatitis
nails - koilonychia
what happens to the pulses of the arms in aortic dissectiom?
disappears in one arm
blood pressure features in aortic dissection (3)
- Hypertension (50% people)
- hypotension (25% of people)
- BP difference >20mmHg between the arms
Why does aortic regurgitation begin in aortic dissection?
the new lumen tracking down into the valve, making it incompetent
Criteria for diagnosing a PE?
WELLS criteria
where is Boerhaave’s perforation located?
the oesophagus - causes by high esophageal pressure and low intrathoracic pressure (E.g .strained vomiting)
Benefits of troponin vs CK-MB for assessing cardiac damage?
troponin is more sensitive + specific to cardiac muscle
Drawbacks of troponin vs CK-MB for assessing cardiac damage?
Troponin has an 8 hour delay that CK-MB doesn’t
What does elevated CK_MB levels >4days after an MI suggest?
reinfarction, as CK_MB levels go back to normal in 2/3 days (troponin high for >7days)
blood tests for cardiac disease (6)
- Troponin - (at time of event then 12 hours after onset)
- serum cholesterol
- FBC - anaemia will cause/exacerbate deficiency in cardiac perfusion
- Urea and electrolytes - (K+ importnat as can cause arrhythmia)
- Inflammatory markers (CRP, ESR, WCC)
- capillary glucose
how are D dimer levels useful for diagnosing PE?
Not useful for diagnosing, as high levels could be caused by fibrin breakdown anywhere. However, low D-dimer can rule out DVT/PE.
What is ST depression in leads V1-V3 consistent with?
anterior NSTEMI
could represent posterior infarct de to the ECG leads being on the opposite sides of the chest wall (for a transmural infarct)
ultimate source for diagnosing MI?
elevated 12 hour troponin
pneumonic for drugs given for acute coronary syndrome
MONABASH
What does MONABASH stand for?
Morphine Oxygen Nitrates Antiplatelets Betablockers Ace inhibitors Statins Heparin *LMWH
What treatment should be provided to patients with STEMI within 12 hours (ideally 2) of the onset of their pain.
angioplasty/thrombolysis
angioplasty is better, but whichever can be delivered quicker will do
When do NSTEMI patients receive thrombolysis?
when their TIMI score >=3
