Session 8 - Chest Pain and Angina

Question 1

Give some respiratory causes of chest pain

Answer 1

• pneumonia

- pulmonary embolism

Question 2

Describe chest pain associated with pulmonary embolism

Answer 2

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

Question 3

Describe chest pain in pneumonia

Answer 3

• not in the centre of the chest

- temperature, cough and breathlessness

Question 4

Give a cause of gastrointestinal chest pain

Answer 4

• acid reflux

Question 5

Describe chest pain from acid reflux

Answer 5

Burning pain running up to the chest or centrally

-worse lying flat or having certain food

Question 6

Give cardiac causes of chest pain

Answer 6

• ischaemic

- pericarditis

Question 7

Describe ischaemic chest pain

Answer 7

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

Question 8

Describe pericarditis chest pain

Answer 8

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

Question 9

Give some musculoskeletal causes of chest pain

Answer 9

• rib fracture

- costochondritis

Question 10

Describe the pain associated with costochondritis

Answer 10

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

Question 11

What is visceral ischaemic chest pain

Answer 11

Pain originating from the organ or tissue

Question 12

What is somatic pain

Answer 12

Pain relating to the pleural sac or pericardial sac

Question 13

Describe visceral pain

Answer 13

• dull, poorly localised

- worse with exertion

Question 14

Describe somatic pain

Answer 14

• sharp pain, well localised

- worse with inspiration, coughing or changing position

Question 15

What is pericarditis

Answer 15

Inflammation of the pericardium often secondary to viral infections

Question 16

Hat may be heard on auscultation in pericarditis

Answer 16

The pericardial rub which is a coarse noise

Question 17

Describe the ECG of someone with pericarditis

Answer 17

• elevated ST with saddle appearance

Question 18

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

Answer 18

False - its a cause of ischaemic cardiac chest pain

Question 19

What is stable angina

Answer 19

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

Question 20

What is a typical patient history of stable angina

Answer 20

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

Question 21

What are acute coronary syndromes

Answer 21

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

Question 22

True or false- stable angina is an acute coronary syndrome

Answer 22

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

Question 23

How do atheromas cause acute coronary syndromes

Answer 23

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

Question 24

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

Answer 24

All of the lumen

Question 25

In unstable angina how much of the lumen is occluded

Answer 25

- only partially occluded but there's worsening ischaemia | - means that pain is still there at rest

Question 26

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

Answer 26

True as there is a very small lumen

Question 27

When are cardiac enzymes released from muscle cells

Answer 27

During infarction so when the muscle cells are dead

Question 28

True or false - cardiac enzymes are released during ischaemia

Answer 28

False - only infarction

Question 29

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

Answer 29

- pain at rest - pain more intense - pain lasts longer - GTN doesn't work - risk of deteriorating further to a NTSTEMI or STEMI

Question 30

Describe the patient history for a myocardial infarction

Answer 30

- 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

Question 31

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

Answer 31

False - they are often normal

Question 32

What diagnostic tests can be done for acute coronary syndrome

Answer 32

- ECG | - blood tests

Question 33

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

Answer 33

Troponin to see if there's myocyte death

Question 34

On an ECG what do patterns of infarct look like

Answer 34

- ST elevation | - hyperacute T waves

Question 35

what may cause an elevated ST wave

Answer 35

- MI | - left bundle branch block

Question 36

months after a STEMI what will the ECG have

Answer 36

prominent Q wave

Question 37

what ECG patterns are seen in ischaemia

Answer 37

- ST depression | - T wave flattening

Question 38

how do you distinguish between a NSTEMI and unstable angina

Answer 38

troponin levels in the blood - troponin is present in NSTEMI

Question 39

what would you look at in blood tests for stable angina

Answer 39

- FBC = looking for anaemia - cholesterol - thyroid function (hypothyroidism can cause anaemia)

Question 40

how will adenosine be used to look for ischaemia

Answer 40

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

Question 41

what medications can be used for stable angina

Answer 41

- aspirin - beta blockers - statin - ACE inhibitors

Question 42

how does aspirin help in stable angina

Answer 42

anti platelet drug so prevents them sticking together

Question 43

what treatments are used for stable angina

Answer 43

- CABG | - angioplasty

Question 44

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

Answer 44

``` STEMI = full occlusion NSTEMI = large occlusion ```

Question 45

what is referred pain

Answer 45

where pain is felt away from the site of origin

Question 46

why does referred pain occur

Answer 46

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

Question 47

what is radiating pain

Answer 47

when the pain starts in one place and moves around

Question 48

what is a percutaneous coronary intervention

Answer 48

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

Question 49

why is an ECG normal for someone with stable angina

Answer 49

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

Question 50

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

Answer 50

quicker, non-invasive and less complications