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CVS * > S9 Chest Pain and Acute Coronary Syndromes > Flashcards

S9 Chest Pain and Acute Coronary Syndromes Flashcards

1
Q

How do you diagnose what a chest pain is due to?

A
  • take a history
  • do a clinical examination e.g. auscultation of chest
  • carry out investigations e.g. ECG and blood tests
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2
Q

What factors do you consider when taking a history?

A 
Site 
Quality 
Intensity 
Timing
Aggravating factors 
Relieving factors
Secondary symptoms

SQUITARS

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3
Q

What respiratory problems can cause chest pain?

A
  • pneumonia - irritates the parietal pleura

* pulmonary embolism - irritates the parietal pleura

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4
Q

What cardiac problems can cause chest pain?

A
  • MI
  • stable/unstable angina
  • pericarditis - non-ischaemic chest pain
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5
Q

What MSK problems can cause chest pain?

A
  • broken rib

* costochondritis - inflammation of costal cartilages

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6
Q

What GI problems can cause chest pain?

A
  • oesophagus - reflux
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7
Q

You can get pleuritic chest pain, which is related to pain in the pleura but also pleuritic chest pain that has similar pain but in different areas, what problems can cause this type of pain?

A
  • pneumonia
  • pulmonary embolism
  • pericarditis
  • broken rib
  • costochondritis
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8
Q

What is cardiac (visceral) pain like?

A
  • dull
  • poorly localised
  • worsened with exertion
  • may radiate to shoulder/jaw
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9
Q

What is pleuritic (somatic) pain like?

A
  • sharp
  • well localised
  • worse with inspiration/coughing/positional movement
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10
Q

What is pericarditis?

A

Inflammation of the pericardium

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11
Q

Who is pericarditis more common in?

A

Men and adults

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12
Q

What is the common cause of pericarditis?

A

Viral

Can also be bacterial e.g. TB, cancer or autoimmune

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13
Q

How does pericarditis present?

A
  • retrosternal (behind sternum) chest pain
  • sharp
  • localised to front of chest
  • aggravated with inspiration, cough, lying flat
  • eased with sitting up and leaning forward
  • pericardial rub may be heard on auscultation
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14
Q

What does the ECG look like for someone with pericarditis?

A

Widespread saddle-shaped ST segment elevation

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15
Q

What is cardiac, ischaemic chest pain due to?

A

Secondary to pathology involving the heart e.g. ischaemic heart disease

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16
Q

What is the pathophysiology of ischaemic heart disease?

A

Atherosclerosis - a build up over time of lipid within the tunica intima/media with a fibrous external cap

17
Q

What are the modifiable risk factors for atherosclerosis and so ischaemic heart disease?

A
  • smoking
  • hypertension
  • dyslipidaemia
  • diabetes
  • obesity
  • sedentary lifestyle
18
Q

What are the non-modifiable risk factors for atherosclerosis and so ischaemic heart disease?

A
  • advanced age
  • family history of ischaemic heart disease
  • male sex
19
Q

What is stable angina?

A

Ischaemia only occurs when metabolic demands of cardiac muscle are greater than what can be delivered via the coronary arteries e.g. when doing exercise

The atherosclerotic plaque is stable

20
Q

What conditions are involved in acute coronary syndrome?

A
  • unstable angina
  • MI - STEMI and NSTEMI

(Stable angina is chronic)

21
Q

What causes acute coronary syndromes?

A

Caused by atherosclerotic coronary artery disease

  • atheromatous plaque ruptures with thrombus formation
  • acute increased occlusion in an already partially occluded lumen * leads to ischaemia and potentially infarction
22
Q

When are cardiac enzymes leaked?

A

When cardiac muscle cell necrosis occurs - infarction - NSTEMI and STEMI

23
Q

What is the typical patient history for someone with unstable angina?

A
  • pain occurs at rest as well as with exertion
  • more intense pain than with stable
  • pain may last longer than with stable
24
Q

What are the ECG changes and blood test - troponin results for someone with unstable angina?

A
  • ST depression, T wave inversion (could be normal)

* negative

25
Q

What is the typical patient history for someone with myocardial infarction?

A
  • present similar to someone wit unstable angina
  • may have pain that spreads to shoulder and jaw
    Autonomic features:
  • nausea
  • sweating
  • pallor
26
Q

What are the ECG changes and blood test - troponin results for someone with myocardial infarction, STEMI and NSTEMI?

A

STEMI - ST elevation and troponin positive

NSTEMI - ST depression, T wave inversion and troponin positive

27
Q

In STEMI what does ECG leads affected help determine?

A

Anatomical location of the ischaemia/infarct

28
Q

Where is ST elevation seen in an inferior STEMI?

A

ST elevation in leads II, III and aVF

CVS * (17 decks)

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