Session 8-Chest Pain And ACS Flashcards
What are some respiratory causes of chest pain?
- pneumonia
- pulmonary embolism
What are some cardiac causes of chest pain?
- ischaemia
- pericarditis
What are some upper GI causes of chest pain?
- reflux
- peptic ulcer disease
What are some musculoskeletal causes of chest pain?
- rib fracture
- costochondritis
What are the characteristics of ischaemic chest pain?
- dull retrosternal pain
- poorly localised
- pain radiates to jaw, neck and shoulders
- worse with exertion
What are the characteristics of chest pain due to pericarditis?
- sharp retrosternal pain
- eased with sitting up and leaning forward
- worse when coughing and taking deep breaths
What are the characteristics of chest pain due to pneumonia?
- raised temperature
- cough
- breathlessness
- vague pain in affected area
What are the characteristics of chest pain due to pulmonary embolism?
- sharp pain
- localised
- worse with inspiration
- cough
What are the characteristics of chest pain due to costochondritis?
- sharp well localised pain
- tender to palpate
- worse with movement of chest wall, coughing and inspiration
What is costochondritis?
Inflammation of costal cartilage
Describe visceral pain
- dull, poorly localised
- worsened with exertion
Describe somatic pain
- sharp pain, well localised
- worse with inspiration, coughing or positional movement
True or false: visceral pain is pain in the pleural sac and pericardial sac
FALSE - lung and heart (somatic is pleural sac and pericardial sac)
What is pericarditis?
Inflammation of pericardium
What can be heard on auscultation in a patient with pericarditis?
Harsh, coarse sound (pericardial rub)
What is synonymous with ischaemic heart disease?
Disease of coronary arteries
What cap does an atherosclerotic plaque have?
Fibrous external cap
What are the modifiable risk factors for atherosclerosis and therefore ischaemic heart disease?
- smoking
- hypertension
- hypercholesterolaemia
- diabetes
- obesity
- sedentary lifestyle
What are the non-modifiable risk factors for atherosclerosis and therefore ischaemic heart disease?
- advanced age
- family history
- male
When does heart tissue ischaemia occur in stable angina?
Only when metabolic demands of cardiac muscle are greater than what can be delivered via coronary arteries
What are the characteristics of stable angina?
- dull, retrosternal chest pain
- triggered by exertion
- relieved by rest
- no chest pain at rest
- may get radiation to neck and shoulders
- don’t feel particularly unwell-no sweating etc
- GTN -> relieve pain
Which conditions are classified as acute coronary syndromes?
- unstable angina
- MI
- NSTEMI
- STEMI
What is an acute coronary syndrome?
Atheromatous plaques rupture with thrombus formation, causing acute increased occlusion, leading to ischaemia
Complete the flow chart:
Atherosclerotic plaque rupture -> __________ aggregation and formation of ___________ -> partially occlusive ____________ -> completely occlusive ___________
Platelet
Thrombus
Thrombus
Thrombus
Which acute coronary syndrome has the greatest occlusion?
STEMI
Which acute coronary syndrome has the least occlusion?
Unstable angina
True or false: unstable angina results in heart tissue ischaemia so there is no cardiac enzyme leak
TRUE
What is released from necrosed cardiac muscle cells in infarctions (NSTEMI/STEMI)?
Cardiac enzymes
What are the features of unstable angina?
Many similarities to stable angina except:
- pain occurs at rest
- pain may be more intense
- pain may last longer
- risk of deteriorating further -> NSTEMI or STEMI
What are the characteristics of a myocardial infarction?
- dull, retrosternal chest pain
- may have history of stable angina
- radiates to neck and shoulders
- worse than stable angina
- chest pain at rest
- look unwell
- features of increased autonomic output -> sweaty, pallor, nauseous
- pain often ongoing for >15 minutes
- nothing makes pain better
Which diagnostic tests are used in suspected acute coronary syndrome?
- ECG
- Blood tests
What does the presence of troponin in the blood indicate?
Cardiac myocyte death
What are the ECG changes in a STEMI?
- ST segment elevation
- hyperacute T waves
What are the ECG changes in unstable angina and NSTEMI?
- ST segment depression
- T wave flattening or inversion
How would you determine if the diagnosis was an unstable angina or NSTEMI?
Blood test - troponin release means cardiac muscle death -> infarct -> NSTEMI
