Session 10 - Ischaemic Heart Disease and Chest Pain (1) Flashcards
Name three organs/systems other CVS which can cause chest pain
Lungs and pleura
GI system
Chest wall
What can be used to distinguish between different types of pain?
Character and type of pain, other special symptoms.
What conditions of lungs and pleura cause chest pain? (3)
Pneumonia
Pulmonary Embolism
Pneumothorax
What conditions of the GI system cause chest pain?
Oesophagus – Reflux
Peptic ulcer disease
Gall Bladder – Biliary colic, cholecystitis
What conditions of the chest wall cause chest pain?
Ribs – fractures, bone metastases
Muscles
Skin (herpes zoster)
Costo-chondral joints
What conditions of the CVS cause chest pain?
Myocardium – Angina, MI
Pericardium – Pericarditis
Aorta – Aortic dissection
What are the two types of risk factors for coronary atheroma?
Modifiable
Non-modifiable
Give three non-modifiable risk factors for coronary artheroma
Increasing Age
Male gender (females catch up after menopause)
Family history
Give seven modifiable risk factors for coronary atheroma
Hyperlipidaemia Smoking Hypertension Diabetes mellitus – Doubles IHD risk Exercise Obesity Stress
What are the four main risk factors for coronary artheroma?
Hyperlipidaemia
Smoking
Hypertension
Diabetes mellitus (doubles IHD)
What type of pain can IHD cause?
Central, retrosternal or left sided
Describe the course of the pain from IHD
Pain my radiate to shoulder and arms, with left side more common that the right
- May radiate along the neck, jaw, epigastrium and back.
Describe the character of the pain from IHD
Crushing, occasionally described as burning epigastric pain (inferior MI)
How does pain from IHD vary?
In intensity, duration, onset and precipitation.
Aggravating and relieving factors and associated symptoms
How does pain from IHD get worse?
Stable angina –> Unstable angina –> MI
Describe the structure of atheromas in stable angina
Atheromatous plaques with a necrotic centre and fibrous cap
What is the effect of atheroma in IHD?
Occlude more and more of the lumen as they build up in coronary vessels. This leaves less space for passage of blood and ischaemia in myocardium
What area is most at risk of ischaemia?
Subendocardial surface, myocardial wall pressure greatest
How does coronary arteries increase O2 uptake?
Increase flow, via vasodilator metabolites (adenosine, K+, H+)
Collateral circulation
O2 uptake already maximum!
What increases myocardial demand?
Heart rate
Wall tension - preload, afterload
Contractility
What does myocardial O2 supply depend on?
Coronary blood flow
- perfusion pressure
- coronary artery resistance
O2 carrying capacity
What is the usual presentation of a STEMI?
- Chest pain not relieved by GTN
- N&V
- May be painless +/- atypical
- Acute pulmonary oedema, SOB, syncope, cardiogenic shock
What are four ECG findings you will see in STEMI?
- ST elevation (see above)
- New LBBB
- +/- T wave inersion
- Pathological Q waves
Give 4 steps in initial management of STEMI
- Airway, Breathing, Circulation
- IV access
- 12-lead ECG
- MONA
