Session 9- Ischaemic Heart Disease Flashcards
how do you reach a diagnosis
history
clinical examination
further investigations
SQITARS
site quality intensity time aggravating factors relieving factors secondary symptoms
musculoskeletal causes of chest pain
costochondritis
rib fracture
gastro-intestinal causes of chest pain
oesophagus-reflux disease
peptic ulcer disease
vascular causes of chest pain
aortic dissection
-
respiratory causes of chest pain
pneumonia
pulmonary embolism
what are the life threatening causes of chest pain
unstable angina
myocardial infarction- STEMI, Non STEMI
what is visceral pain
typical cardiac pain from heart ischaemia or infarct worsened with exercise/ exertion
where does visceral pain originate from
deeper structres- lungs heart
how is visceral pain felt
dull
felt centrally
referred pain- felt as arising from another location- jaw, neck and arm
where does somatic pain orginate
superficial structures
chest wall, pericardium, parietal pleura
how is somatic pain felt
sharp
what is somatic pain
worsened with chest movement- breathing in coughing
what is ischaemic heart disease
insufficient blood supply to heart muscle due to artherosclerotic disease of coronary arteries
- stable angina
- unstable angina
- NSTEMI
- STEMI
Pathophysiology of acute coronary syndrome
- atheleroscleroisis leads to stable occlusion
- plaque rupture
- thrombus formation
- sudden increased occulusion
- ischaemia and potentially infarction- myocardial tissue necrosis
- severity of occlusion determines NSTEMI/STEMI
how will stable angina present in a history
cardiac sounding chest pain
aggravated by exercise
relieved with rest
10/15 mins
what will NSTEMI/STEMI show in investigations
rise in troponin
ECG- ST segment elevation-STEMI
unstable angina investigation
no infarction- no rise in troponin
ST depression
T wave changes
