Session 9 - Chest Pain and acute ACS Flashcards
outline the three elements of diagnosing chest pain
take a history - family ect
Clinical exampination - squitars ect
investigations - ECG changes and Blood troponin levels
draw a differential diagnosis for chest pain
check against lecture 16
outline what each of the symptoms are
chest pain
cardiac vs pleuritic (pleural and pericardial)
what differentiates ?
cardiac pain is dull and poorly localised
stable angina is worse with exertion and better at rest
Stemi and Non-Stemi the pain can radiate to arm, shoulder, jaw
somatic pain - pleuritic - the pain is sharp and well localised - is worsened with breathing or coughing or lying down
outline the disease pericarditis
inflammation of the pericardium
often secondary to a viral illness
pain is retrosternal
sharp pain in front of the chest
worse with a cough, lying flat, inhalation
better with sitting up and leaning forward
pericardial rub may be heard on auscultation
what is the ecg pattern seen in pericarditis ?
you will see - saddle shaped ST segment elevation across all/many leads
important to differentiate from an MI
what is the common pathophysiology of ischaemic heart disease
what are the risk factors
formation and rupture of an atherosclerotic plaque - leading to a thrombus formation that will partially or totally occlude the coronary vessel and reduce the oxygen to the heart below what is needed
this is often acute coronary syndrome - ACS - acute myocardial ischemia via plaque
risk factors
modifiable - smoking, diabetes, hypertension, obesity/sedentary, dyslipidaemia
non-modifiable - old age, male, family history of IHD
what is a stable angina - how do you differentiate between it and a unstable angina ?
a stable angina is a narrowed artery by a atherosclerotic plaque
ischemeia only occurs during exertion (ie walking up stairs) and is relived by rest - this is as heart cannot meet increased demands to supply O2 to heart tissue
the differential is that an unstable angina is not relived by rest and the pain will be present at rest
what conditions are included in ACS ?
unstable angina - heart tissue ischemia but no tissue death - risk of developing into an MI
STEMI and Non STEMI via an occlusive thrombus from atherosclerotic plaque rupture and platelet aggregation
all of these the patient may seem sweaty and pale/unwell
how do you differentiate between an unstable angina and a NON STEMI
both conditions may show ST segment depression and T wave inversion on an ECG
the diffence is in ishcemia there is no cell death and there is death in an MI
so in an MI dead tissue would release cardiac enzymes such as tropoin (marker of an MI) - would not be seen in an unstable angina
what is seen in a STEMI, how do you differentiate with a Non STEMI
how do you determine how far along the MI is ?
both show troponin release on blood samples as they are both infarcts
STEMI you see ST segment elevation - minutes
T wave inverison - hours
possible pathological Q waves - days
normal ST and T waves but Q wave remains - weeks/months
allows us to determine how far along the MI is
NON STEMI - ST segment depression and T wave inversion
what are echocardiograms and invasive coronary angiograms
echocardiograms - visulase heart real time, can see valvular issues ect
is non invasive
invasive coronary angiograms - enter through a blood vessel
visualise the vessels and chambers of heart, look for issues
it is invasive but allows in situ fixing if a problem is found
what are the lead regions ?
II, III, AvF - inferior region of heart
Lead I, AvL, V5 and V6 - Lateral region
V1 - V4 - anteroseptal
