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Session 8 Flashcards

1
Q

Name two respiratory causes of chest pain

A

Pneumonia

Pulmonary embolism

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2
Q

Describe how a patient with chest pain as a result of pneumonia will present

A

With VAGUE chest pain described

In lung that the infection is in

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3
Q

Describe how a patient with chest pain as a result of pulmonary embolism will present

A

Sharp pain
Well localised
Worse when breathing in/coughing

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4
Q

What makes the chest pain seen in pulmonary embolism worse?

A

Breathing in/coughing

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5
Q

What happens in pulmonary embolism?

A

There is blockage in a vessel of the pulmonary circulation by an emboli

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6
Q

Describe two cardiac causes of chest pain

A

Ischaemic

Pericarditis

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7
Q

Describe how a patient with ischaemic chest pain will present

A

Dull pain at the centre of the chest

May radiate

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8
Q

What is the term given to the a pain in the CENTRE of the chest?

A

Retrosternal

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9
Q

Where might the chest pain as a result of ischaemia radiate?

A

Jaw
Neck
Shoulders

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10
Q

Describe how localised the pain is in chest pain caused by PE compared to chest pain caused by ischaemia

A

Chest pain as a result of ischaemia less localised than in PE

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11
Q

Name an aggravating factor in chest pain due to ischaemia

A

Exertion

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12
Q

What is pericarditis?

A

Inflammation of the pericardial sac

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13
Q

Describe how a patient with chest pain due to pericarditis will present

A

Sharp pain

Centre of chest (retrosternal)

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14
Q

What are some relieving factors in chest pain as a result of pericarditis?

Aggravating factors?

A

Sitting up
Leaning forward

Lying flat
Deep breaths
Coughing

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15
Q

What sound might be heard as a result of (chest pain due to) pericarditis?

A

Pericardial rub (coarse heartbeat)

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16
Q

What is pericardial rub?

A

The coarse heartbeat sound heard in individuals with pericarditis

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17
Q

How can pericarditis affect an ECG?

A

ST segment elevation

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18
Q

What is an upper GI cause of chest pain?

A

Reflux

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19
Q

What happens in reflux?

A

Acidic contents of the stomach goes up into the oesophagus

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20
Q

Describe how a patient with chest pain as a result of reflux will present

A

Burning pain

Centrally/Running up the chest

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21
Q

What are some aggravating factors of chest pain due to reflux?

A

Lying flat

Worse after food

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22
Q

Describe two musculoskeletal causes of chest pain

A

Rib fracture

Costochondritis

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23
Q

Describe how a patient with chest pain as a result of a rib fracture will present

A

Sharp pain
Localised
Tender to palpate

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24
Q

What are some aggravating factors of chest pain due to rib fracture?

A

Movement of chest wall - e.g. Inspiration/Coughing

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25
Q

What is costochondritis?

A

Inflammation of the costal cartilages of the ribs

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26
Q

Describe how a patient with chest pain as a result of costochondritis will present

A

Sharp pain
Localised
Tender to palpate

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27
Q

What are some aggravating factors of chest pain due to costochondritis?

A

Worse with chest wall movement - inspiration/coughing

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28
Q

Describe pleural/pericardial pain with cardiac ischaemic chest pain

A

Cardiac ischaemic chest pain

  • visceral pain
  • dull, poorly localised
  • worse with exertion

Pleural/pericardial pain

  • somatic pain
  • sharp, well localised
  • worse with inspiration/coughing
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29
Q

Describe the aggravating factors of cardiac ischaemic chest pain compared to pleural/pericardial chest pain

A

Pleural pericardial - inspiration/coughing/movement

Cardiac ischaemic - exertion

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30
Q

Name a cardiac…

I) ischaemic
II) non-ischaemic

…cause of chest pain

A

Ischaemia, Infarction

Pericarditis

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31
Q

Name 6 non-cardiac causes of chest pain

A

Pneumonia
Pulmonary embolism

Reflux

Costochondritis
Rib fracture

Aortic dissection

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32
Q

What is atherosclerosis? What effect does it have on arteries?

A

Build up of fat in arteries

Narrows them, plaque/atheroma production

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33
Q

Describe the structure of the plaques seen in atherosclerosis

A

Lipid-laden core with a fibrous cap

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34
Q

What is ischaemic heart disease?

A

Disease of the coronary arteries

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35
Q

The risk factors for atherosclerosis are the same as the risk factors for…

A

IHD

Ischaemic Heart Disease

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36
Q

State 6 modifiable risk factors for atherosclerosis and ischaemic heart disease

A 
Smoking
Hypertension 
Hypercholesterolaemia 
Diabetes
Obesity 
Sedentary lifestyle
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37
Q

State 3 non-modifiable risk factors for atherosclerosis and ischaemic heart disease

A

Age (older)
Gender (male)
Family history

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38
Q

Angina is caused by the ____________ of coronary arteries

This is usually as a result of…

A

Occlusion

Atherosclerosis

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39
Q

Describe the atherosclerotic plaque seen in stable angina

A

It is stable

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40
Q

When does heart tissue ischaemia occur?

A

When the metabolic demands of cardiac muscle are greater than what can be delivered by the coronary arteries

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41
Q

Describe how a patient with stable angina will typically present

A

Dull retrosternal pain

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42
Q

The pain experienced in stable angina is triggered by…

A

Exertion

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43
Q

Why does exertion trigger the pain seen in stable angina?

A

Blood flow through the narrowed coronary arteries is not adequate for the increased demands of cardiac muscle

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44
Q

What is the chest pain seen in stable angina relieved by?

A

Rest

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45
Q

In someone with stable angina, is the chest pain seen during rest?

46
Q

What drug can be given to someone experiencing chest pain as a result of stable angina?

47
Q

What is acute coronary syndrome?

A

Acute myocardial ischaemia caused by atherosclerotic coronary artery disease

48
Q

Acute coronary syndromes include which 4 conditions?

A

Unstable angina
MI
NSTEMI
STEMI

49
Q

When can an atherosclerotic plaque cause acute coronary syndrome/ischaemia?

A

Atherosclerotic plaque ruptures and a thrombus forms causing an acute increased occlusion of the coronary artery

50
Q

What happens once an atherosclerotic plaque ruptures in a coronary artery?

A

Platelet aggregation and formation of a thrombus resulting in partially-completely occluded coronary artery

51
Q

Compare the size of the coronary artery lumen seen in…

Unstable Angina
NSETMI
STEMI

A

Unstable Angina - partially occluded lumen
NSTEMI - more occluded
STEMI - completely occluded

52
Q

Do cardiac enzymes leak out of ISCHAEMIC cardiac cells?

53
Q

Do cardiac enzymes leak out of infarcted (necrosed) cardiac cells?

54
Q

Unstable angina has many similarities to stable angina. What is the main different symptom between the two?

Name 3 other potential differences

A

Unstable Angina - chest pain occurs at rest

Pain more intense
Pain lasts longer
GTN spray no longer works

55
Q

Does GTN spray work to relieve chest pain in unstable angina?

56
Q

Unstable angina has a risk of deteriorating further to…

A

NSTEMI

STEMI

57
Q

Describe the pain experienced by someone with MI

A

Dull, retrosternal/central pain
Chest pain is experienced at rest
Pain may radiate to neck/shoulders

58
Q

Do patients with MI experience their chest pain at rest?

59
Q

Where may the pain experienced by a patient with MI radiate to?

A

Neck

Shoulders

60
Q

Is the chest pain experienced in MI usually dull or sharp?

Where is the pain usually located?

A

Dull

Centrally (retrosternal)

61
Q

Describe the typical general appearance of someone with MI

A

Looks unwell
Sweaty
Pallor
Nauseous

62
Q

Sweaty, pallor and nauseous may all be features of a patient presenting with MI, what do these features indicate?

A

Increased autonomic output

63
Q

The pain with MI usually lasts longer than ____ minutes with _______________ onset

A

15

Spontaneous

64
Q

MI can be ‘painless’ in which individuals?

65
Q

What are two diagnostic tests used for suspected acute coronary syndrome?

A

ECG

Blood Tests

66
Q

What sections of the ECG would you look at/for when investigating suspected acute coronary syndrome?

A

ST Segments
T Waves
Pathological Q Waves

67
Q

What would be specifically looked for in blood tests for suspected acute coronary syndrome?

A

Troponin levels

68
Q

Troponin in the blood indicates…

A

Cardiac myocyte death

69
Q

What acute ECG changes are seen in STEMI?

A

ST segment elevation

Hyper-acute T waves

70
Q

Describe the appearance of hyper-acute T waves

A

Big + Pointy

71
Q

ST elevation will be seen on which leads of an ECG in a STEMI?

A

Leads facing the damaged part of the heart

72
Q

Describe the evolution of a STEMI on an ECG in the following different stages…

I) minutes-hours
II) hours-day
III) week
IV) months

A

ST elevation
Hyperacute T waves

ST elevation
T inversion
Pathological Q waves (deeper)

Reduction in ST elevation
T inversion (smaller)
Pathological Q wave (deeper)

Pathological Q wave persists

73
Q

What ECG changes are seen as a result of a STEMI in the first few minutes/hours?

A

ST elevation

Hyper-acute T waves

74
Q

What ECG changes are seen in a STEMI after a few hours- a day?

A

ST elevation
T inversion
Pathological Q waves

75
Q

What ECG changes are seen in a STEM after a week?

A

Less ST elevation
Pathological Q waves
Less deep T inversion

76
Q

What ECG change may be seen in a STEMI after months?

A

Pathological Q waves

77
Q

Describe the ECG changes seen in unstable angina/NSETMI

A

ST Depression

T Wave Flattening/Inversion

78
Q

Both unstable angina and NSTEMI show similar ECG features (ST segment depression/T inversion or flattening). How are the two distinguished?

A

By checking troponin levels

79
Q

Ischaemic heart disease relates to disease affecting the ____________ _________ usually _________________

A

Coronary arteries

Atherosclerosis

80
Q

Acute coronary syndromes include which 3 conditions? What development of atherosclerosis usually causes acute coronary syndromes?

A

Unstable Angina
NSTEMI
STEMI

Acute plaque rupture

81
Q

What is the most usual cause of stable angina? How does this result in stable angina?

A

Coronary artery stenosis

Reduced perfusion of myocardium

82
Q

Other than coronary artery stenosis name two other potential causes of stable angina

A

Anaemia
Severe aortic valve stenosis
Hyperthyroidism

83
Q

Why can severe aortic valve stenosis result in stable angina?

A

Not enough blood travels through coronary arteries from LV

84
Q

Name three investigations that may be carried out in stable angina

A

Bloods
ECG
Chest X-ray

85
Q

What may be looked at in the blood during investigations for stable angina?

A

FBC (anaemia?)
Cholesterol
Troponin (not present in stable angina)

86
Q

Why might a resting ECG be used in investigations for stable angina?

A

May give indications of previous MI (e.g. Q waves), rhythm disturbances, AF

87
Q

What tests can be used to test for ischaemia and its extent (4)

A

Treadmill test
Dobutamine stress echo
Treadmill stress echo
Myocardial perfusion stress test

88
Q

What happens in treadmill tests?

A

ECG/BP is measure whilst exercise is carried out

89
Q

What happens in a dobutamine stress echo?

A

Medication is used to stress the heart and echocardiogram carried out

90
Q

What happens in a treadmill stress test?

A

Exercise is used to stress the heart and echocardiogram is carried out

91
Q

What happens in myocardial perfusion stress test?

A

Maximum vasodilation achieved with drugs and if there is a stenosis in an artery, a patch will show up on imaging

92
Q

Name 7 potential treatments for stable angina

A 
Aspirin 
Beta blocker
Statin 
ACE inhibitor 
Oral nitrate 
Nicorandil 
CCB (Ca Channel Blockers)
93
Q

How does aspirin work in the treatment of stable angina?

A

Acts as an anti-platelet drug preventing platelets sticking together

94
Q

What two effects do beta blockers have?

A

Slows the heart rate

Drops the blood pressure

95
Q

How do statins work in the treatment of stable angina?

A

Reduce LDL cholesterol build-up

96
Q

How does oral nitrate work compared to GTN spray in the treatment of stable angina?

A

Longer lasting

Oral

97
Q

What effect do calcium channel blockers have on an individual’s blood pressure?

A

Anti-hypertensive (reduced bp)

98
Q

Name two different revascularisation treatments used when there is plaque blockage of coronary arteries

A

Percutaneous coronary intervention (PCI)

Coronary artery bypass grafting (CABG)

99
Q

What happens in PCI (percutaneous coronary intervention)and how is it carried out?

A

A non-surgical procedure where a catheter is used to place a stent in atherosclerotic coronary arteries to open them up

100
Q

What happens in CABG (coronary artery bypass grafting)?

A

Other vessels are grafted around the coronary artery with plaque blockage to supply more blood to the area by bypassing the narrowing

101
Q

Give two examples of vessels that may be grafted during CABG?

A

Saphenous vein

Internal mammary artery

102
Q

What is the usual cause of unstable angina?

A

Coronary plaque rupture

103
Q

Name 4 typical investigations that could be carried out in suspected acute coronary syndrome

A

Bloods
ECG
Troponin
Chest X-Ray

104
Q

Describe the occlusion of a coronary artery seen in STEMI

A

Acute total occlusion of a major coronary artery seen

105
Q

Describe the occlusion of a coronary artery seen in NSTEMI

A

Acutely progressive tight stenosis of a coronary artery

106
Q

Name 4 cardiac conditions where you may see troponin released

A 
ACS
Myocarditis 
Cardiac Amyloidosis 
Aortic Dissection 
Acute Heart Failure 
Prolonged Tachycardia
107
Q

Name 3 non-cardiac conditions where you may see troponin released

A 
Acute PE
Pulmonary hypertension 
Sepsis
Severe anaemia 
Kidney failure 
Cardiac amyloidosis
108
Q

What is a problem with using troponin as a marker for myocardial damaged?

A

It has poor specificity and is released in almost any condition

109
Q

The treatments of unstable angina/MI are aimed at…

A

Treating the symptoms/prognosis

110
Q

How would unstable angina be treated?

A

By optimising general condition
Drugs (Pharmacological)
Reperfusion - e.g. CABG/PCI

111
Q

How would myocardial infarction be treated?

A 
Oxygen 
Pain relief 
GTN sublingually
Aspirin (anti-platelets)
Reperfusion - e.g. CABG/PCI

CVS (8 decks)

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