Session 9: Causes of Chest Pain Flashcards
What is the mnemonic for history taking? Explain it.
SQITARS Site: location and if it radiates Quality: how does the pain feel (dull, sharp, burning etc.) Intensity: how bad is the pain Timing: when it started, sudden or gradual onset Aggravating factors: what makes it worse Relieving factors: what makes it better Secondary symptoms
Give examples of causes of chest pain.
Musculoskeletal and skin pain Pleuritic pain (relating to lungs and pleura) Cardiac pain (heart and pericardium) Aorta (aortic dissection e.g.) Others like oesophagus (acid reflux)
What does acute coronary syndrome include?
Unstable angina, myocardial infarction (both NSTEMI and STEMI)
Is there any other type of chest pain associated with the heart? (most common)
Stable angina and pericarditis.
What is a stable angina and when does it occur?
It’s pain in the chest when heart tissue gets ischaemic ONLY when metabolic demands of cardiac muscle are greater than what can be delivered via coronary arteries. In a stable angina the atherosclerotic plaque is also stable. It is normally due to an atherosclerotic plaque which partially obstructs a coronary artery.
Describe the pain of a stable angina.
No chest pain at rest, only during exertion of some sort like exercise, climbing stairs etc. Dull, crushing pain during exercise. Not associated with sweating, nausea or vomiting.
How would a stable angina look on an ECG?
Can look completely normal. However during exercise (while on ECG) there might be ST depression and/or T inversion.
Describe the pain of an unstable angina compared to the pain of a stable angina. What’s the risk of an unstable angina?
Many similarities to stable angina however: The pain also occurs at rest. There’s usually deteriorating symptom control. The pain may be more intense and the pain may last longer. Since the atherosclerotic plaque is also unstable there is an increased risk of NSTEMI and STEMI.
Describe the pain of a myocardial infarction according to SQITARS.
Central pain, dull, crushing. Radiating, shoulder, jaw, neck, arms, and even ears sometimes, pain usually in C4 to T4. Sweating, nausea and pale-looking is common. Sudden onset.
How would stable angina differ from acute coronary syndromes?
Stable anginas should have no chest pain at rest. In case of ACS patient may appear sweaty, anxious and pale.
To distinguish between Unstable angina, NSTEMI, and STEMI how would you proceed further?
Investigation such as ECG and blood tests.
How would the ECG differ from an unstable angina, an NSTEMI and a STEMI?
A STEMI would have a ST segment elevation and usually hyperacute T waves. Also new left bundle branch block. In an NSTEMI or unstable angina there would be no ST segment elevation but a ST segment depression and/or T wave flattening or inversion.
In the case of an inferior STEMI, which leads would pick up changes?
II, III and avF. ST segment elevation and possible hyperacute T waves.
If an unstable angina and an NSTEMI looks the same on an ECG as they normally do, how would you further investigate to discern what it is?
Full blood test to look for a rise in troponin I and troponin T. In an NSTEMI there would be a rise in troponin but none in an unstable angina.
Give modifiable risk factors for atherosclerosis.
Smoking Hypertension Dyslipidaemia Diabetes Obesity Sedentary lifestyle
Label the very next boxes. (Follow up card will come) 6 boxes in total.
Label the rest.
