Session 9 - Chest Pain and Acute Coronary Syndromes Flashcards
What are 2 main classifications of chest pain?
Cardiac
Pleuritic
What is visceral pain?
Typical cardiac pain from heart ischaemia or infarct
What is somatic pain?
Pleuritic chest pain
Where does visceral pain originate from?
Deeper structures via visceral afferent nerves
How does visceral pain feel like?
Dull, poorly localized but central
Where does somatic pain originate from?
Chest wall, pericardium and parietal pleura via somatic afferent nerves
How does somatic pain feel like?
Sharp, well localized, often non central
When is cardiac pain worsened?
Exercise and exertion
When is pleuritic pain worsened?
Chest movement like breathing in and coughing
What are 2 types of cardiac causes for chest pain?
Acute coronary syndromes
Pericarditis
What is pericarditis?
Inflammation of pericardium
What would you hear when examining patient with pericarditis?
Pericardial rub
What is ischaemic heart disease?
Insufficient blood supply to heart muscle due to atherosclerotic disease of coronary arteries
What are 4 types of ischaemic heart disease?
Stable angina
Unstable angina
NSTEMI
STEMI
What is the pathophysiology of acute coronary syndrome?
Atherosclerosis causes stable occlusion, plaque ruptures and forms a thrombus which suddenly increases occlusion, leading to ischaemia and potentially infarction and causes acute coronary syndromes
What determines the kind of acute coronary syndrome you get?
Severity of occlusion
What is the difference between stable and unstable angina?
Angina not present during rest for stable angina
What is the similarity in terms of ECG for stable and unstable angina?
ST depression
What is a key differentiating factor between NSTEMI/STEMI and angina?
Troponin elevated in blood tests
What’s the difference between NSTEMI and STEMI?
ST elevation for STEMI
Non ST elevation or ST depression for NSTEMI
What are the 5 stages of ECG changes for STEMIs?
Acute - ST elevation
Hours - ST elevation, decreased R wave, Q wave begins
Day 1-2 - T wave inversion, Q wave deeper
Days later - ST normalizes, T wave inversion
Weeks later - ST and T normal, Q wave persists
