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Phase 1 - S2 Cardiovasular System > Session 8 - Chest Pain and Angina > Flashcards

Session 8 - Chest Pain and Angina Flashcards

1
Q

Give some respiratory causes of chest pain

A
  • pneumonia

- pulmonary embolism

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2
Q

Describe chest pain associated with pulmonary embolism

A
  • to the side of the chest
  • sharp
  • localised
  • worse when they breath in or cough
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3
Q

Describe chest pain in pneumonia

A
  • not in the centre of the chest

- temperature, cough and breathlessness

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4
Q

Give a cause of gastrointestinal chest pain

A
  • acid reflux
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5
Q

Describe chest pain from acid reflux

A

Burning pain running up to the chest or centrally

-worse lying flat or having certain food

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6
Q

Give cardiac causes of chest pain

A
  • ischaemic

- pericarditis

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7
Q

Describe ischaemic chest pain

A
  • dull pain in the retrosternal
  • poorly localised
  • may radiate pain into the jaw, shoulder and neck
  • worse with exertion
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8
Q

Describe pericarditis chest pain

A
  • sharp pain in the retrosternal
  • eased when sitting up and leaning forward
  • coughing and deep breathing make it worse
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9
Q

Give some musculoskeletal causes of chest pain

A
  • rib fracture

- costochondritis

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10
Q

Describe the pain associated with costochondritis

A
  • sharp pain
  • tender to palpate
  • worse when coughing or breathing in
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11
Q

What is visceral ischaemic chest pain

A

Pain originating from the organ or tissue

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12
Q

What is somatic pain

A

Pain relating to the pleural sac or pericardial sac

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13
Q

Describe visceral pain

A
  • dull, poorly localised

- worse with exertion

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14
Q

Describe somatic pain

A
  • sharp pain, well localised

- worse with inspiration, coughing or changing position

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15
Q

What is pericarditis

A

Inflammation of the pericardium often secondary to viral infections

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16
Q

Hat may be heard on auscultation in pericarditis

A

The pericardial rub which is a coarse noise

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17
Q

Describe the ECG of someone with pericarditis

A
  • elevated ST with saddle appearance
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18
Q

True or false - atherosclerosis is a cause of non ischaemic chest pain

A

False - its a cause of ischaemic cardiac chest pain

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19
Q

What is stable angina

A

Where heart tissue ischaemia only occurs during exercise as the occlusion of the arteries by the atheroma only compromises the demand of the heart during this increased requirement

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20
Q

What is a typical patient history of stable angina

A
  • chest pain when exercising
  • dull, retrosternal pain
  • no pain at rest
  • radiating pain to neck and shoulder
  • GTN spray relieves pain
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21
Q

What are acute coronary syndromes

A

Problems which cause a sudden reduction in blood flow to the heart

22
Q

True or false- stable angina is an acute coronary syndrome

A

False - stable angina does not cause sudden reduction of blood flow

23
Q

How do atheromas cause acute coronary syndromes

A

The atherosclerotic plaque ruptures, platelets aggregate and a thrombus forms. This can then completely occlude the lumen.

24
Q

How much of the lumen is occluded in an STEMI resulting acute coronary syndrome

A

All of the lumen

25
Q

In unstable angina how much of the lumen is occluded

A
  • only partially occluded but there’s worsening ischaemia

- means that pain is still there at rest

26
Q

True or false - there is infarction of tissue in Non-STEMIs

A

True as there is a very small lumen

27
Q

When are cardiac enzymes released from muscle cells

A

During infarction so when the muscle cells are dead

28
Q

True or false - cardiac enzymes are released during ischaemia

A

False - only infarction

29
Q

What are the difference in the the patient history of unstable angina and stable angina

A
  • pain at rest
  • pain more intense
  • pain lasts longer
  • GTN doesn’t work
  • risk of deteriorating further to a NTSTEMI or STEMI
30
Q

Describe the patient history for a myocardial infarction

A
  • dull, retrosternal pain (more severe than angina) for more than 15 mins
  • radiates to neck and shoulders
  • looks unwell
  • increased autonomic output
  • GTN spray and resting doesn’t help
31
Q

True or false - clinical examinations for stable angina and acute coronary syndromes will always be abnormal

A

False - they are often normal

32
Q

What diagnostic tests can be done for acute coronary syndrome

A
  • ECG

- blood tests

33
Q

What are you looking for in blood tests for suspected acute coronary syndromes

A

Troponin to see if there’s myocyte death

34
Q

On an ECG what do patterns of infarct look like

A
  • ST elevation

- hyperacute T waves

35
Q

what may cause an elevated ST wave

A
  • MI

- left bundle branch block

36
Q

months after a STEMI what will the ECG have

A

prominent Q wave

37
Q

what ECG patterns are seen in ischaemia

A
  • ST depression

- T wave flattening

38
Q

how do you distinguish between a NSTEMI and unstable angina

A

troponin levels in the blood - troponin is present in NSTEMI

39
Q

what would you look at in blood tests for stable angina

A
  • FBC = looking for anaemia
  • cholesterol
  • thyroid function (hypothyroidism can cause anaemia)
40
Q

how will adenosine be used to look for ischaemia

A

adenosine causes vasodilation of the coronary arteries allowing you to see a blockage

41
Q

what medications can be used for stable angina

A
  • aspirin
  • beta blockers
  • statin
  • ACE inhibitors
42
Q

how does aspirin help in stable angina

A

anti platelet drug so prevents them sticking together

43
Q

what treatments are used for stable angina

A
  • CABG

- angioplasty

44
Q

what is the difference in occlusion of an artery of a STEMI and NSTEMI

A 
STEMI = full occlusion
NSTEMI = large occlusion
45
Q

what is referred pain

A

where pain is felt away from the site of origin

46
Q

why does referred pain occur

A

the afferent signals of pain from the heart go to the brain along the same passageway as the dermatomes T1-T4. the brain then confuses the messages and presumes the pain is in the dermatomes so does this through the efferent signals

47
Q

what is radiating pain

A

when the pain starts in one place and moves around

48
Q

what is a percutaneous coronary intervention

A

a non-surgical procedure where a balloon catheter is inserted through the femoral or radial artery and is used to inflate the coronary artery. A metal stent is then added

49
Q

why is an ECG normal for someone with stable angina

A

at rest there is no significant occlusion to the blood flow so the demands of the heart are met

50
Q

what are the advantages of a coronary angiogram to a catheter angiogram

A

quicker, non-invasive and less complications

Phase 1 - S2 Cardiovasular System (16 decks)

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