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PARA2007 > WEEk 3 - Chest Pain > Flashcards

WEEk 3 - Chest Pain Flashcards

1
Q

Causes of chest pain

A

Either cardiac related or non cardiac related

Cardiac related
- myocardial infarction
- angina
- arrhythmia
- pericarditis
- pulmonary oedema

Non cardiac
- bruised or fractured rib
- aortic dissection
- gastro oesophageal reflux disease (GORD)
- pulmonary embolism
- anxiety

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2
Q

What ECG results indicate early myocardial infarction

A

The earliest signs of acute myocardial infarction are subtle and include increased T wave amplitude over the affected area. T waves become more prominent, symmetrical, and pointed

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3
Q

What are the risk factors of an MI?

A
  • hypercholesterolaemia
  • hypertension
  • tobacco use
  • diabetes
  • sedentary lifestyle
  • male gender
  • genetics.
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4
Q

When does an MI occur?

A
  • when a blood clot completely obstructs a coronary artery supplying blood to the myocardium, causing ischaemia and necrosis
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5
Q

What is angina?\

A

is chest discomfort that occurs when there is decreased blood oxygen supply to an area of the heart muscle

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6
Q

What causes the lack of blood supply in angina?

A

In most cases, the lack of blood supply is due to a narrowing of the coronary arteries as a result of arteriosclerosis. Consequently, angina can be caused by coronary artery disease or spasm of the coronary arteries.

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7
Q

Symptoms of an MI

A
  • chest, arm or jaw pain
  • shortness of breath
  • nausea
  • general lethargy
  • diaphoresis
  • however some patients may be totally asymptomatic.
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8
Q

How are MI’s diagnosed

A

They are diagnosed by ECG findings and measurement of cardiac enzymes in blood, such as creatinine kinase (CK) and Troponins T and I.

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9
Q

Symptoms of angina

A
  • usually felt as pressure
  • heaviness
  • tightening, squeezing, or aching across the chest, particularly behind the sternum (similar to an MI), which often radiates to the neck, jaw, arms, back or even the teeth

Other signs and symptoms of angina include
- indigestion
- heartburn
- generalised weakness
- diaphoresis
- nausea
- cramping
- shortness of breath.

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10
Q

What normally exacerbates angina?

A

exertion, severe emotional stress or after a heavy meal, when the myocardium demands more oxygenated blood than the narrowed coronary arteries can deliver.

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11
Q

What relieves angina?

A
  • Rest and/or nitroglycerin, which dilates the blood vessels, allowing more oxygen to get to the myocardium.
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12
Q

What are the classifications of angina? (3 types)

A
  • stable
  • unstable
  • prinzemetal’s
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13
Q

What is stable angina?

A
  • Stable angina is the most common type of angina and what most people mean when they refer to angina
  • People with stable angina have angina symptoms on a regular basis and the symptoms are somewhat predictable (for example, walking up a flight of stairs causes chest pain)
  • For most patients, symptoms occur during exertion and commonly last less than five minutes.
  • They are relieved by rest and/or medication.
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14
Q

What is unstable angina?

A
  • UAP is less common but more serious
  • The symptoms are more severe and less predictable than the pattern of stable angina
  • Pain is more frequent, lasts longer, occurs at rest, and is not relieved by nitroglycerin (or the patient needs to use more nitroglycerin than usual to elicit relief)
  • It is often a precursor to an MI.
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15
Q

What is prinzmetal’s angina?

A
  • This is caused by a spasm in a coronary artery, temporarily decreasing blood supply to a section of the myocardium
  • It is rare and also unpredictable and may not be relieved with rest and medication.
  • Sometimes it is difficult to distinguish between angina and an MI, despite the patient history, and so again anybody with chest pain of a cardiac cause should be transported to hospital.
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16
Q

What is an arrhythmia?

A

an abnormal heart rhythm, and can be either benign or serious

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17
Q

Symptoms of an arrhythmia

A
  • palpitations
  • chest pain
  • dizziness or syncope
  • Diaphoresis
  • shortness of breath
  • light-headedness
  • fullness in the throat or neck, or generalised weakness
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18
Q

most common presentations of arrhythmias

A
  • palpitations (“heart racing”)
  • tachyarrthymias (SVT and VT often resulting in ‘rate related’ chest pain)
  • bradyarrhythmias (SSS and AV blocks).
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19
Q

Diagnosis of an arrhythmia

A

Diagnosis of an arrhythmia is made using a number of different tests including; an ECG, stress test, halter-monitor, Tilt Test, electrophysiology studies (EPS) or chest x-rays.

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20
Q

What is pericarditis?

A

the inflammation of the pericardium (the sac-like membrane which surrounds the heart and protects it from overstretching)

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21
Q

What causes pericarditis?

A
  • unknown
  • may result from mechanical injury to the heart, viral or bacterial infections, tumors or cancer, connective tissue disease, metabolic diseases or reactions to medications.
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22
Q

Symptoms of pericarditis

A
  • chest pain (which is almost always present), which may be sharp in nature
  • Pain may radiate to the back, neck, arm or shoulder blade and can often be made worse with deep breathing or swallowing.
  • The pain is usually positional and can often be made worse by lying flat and better when leaning forward.
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23
Q

What is an indication of pericarditis on an ECG

A
  • global ST elevation
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24
Q

Prehospital management of pericarditis

A

In the prehospital setting treatment is limited, and would revolve around analgesia and transport for further management. Due to the severe chest pain the patient may present with, and the ST-elevation on the ECG, it may be confusing and look like an MI!

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25
Q

Why do patients tend to not take breaths when suffering from a rib fracture?

A

Due to the nature of ventilation and respiration, when a person has a rib injury, the pain associated with that injury makes breathing difficult

26
Q

Management of rib fractures in the pre hospital setting

A

management involves analgesia and constant reassessment of ABCs to identify any complications.

27
Q

What is an aortic dissection?

A

when a tear occurs in the inner muscle wall lining of the aorta, allowing blood to split the muscle layers of the aortic wall apart

28
Q

What are the two types of aortic dissection?

A
  • Type A
  • Type B
29
Q

What are the risk factors associated with aortic dissection?

A
  • High BP
  • high cholesterol
30
Q

What are the symptoms of an aortic dissection?

A
  • a tearing or ripping pain in the chest or back
  • sweating
  • nausea
  • shortness of breath
  • weakness
  • syncope
  • The patient will often present with different blood pressures on each side of the body
  • signs of poor perfusion.
  • The symptoms are mainly as a result of reduced blood flow to parts of the body.
31
Q

Prehospital treatment of an aortic dissection

A

Prehospital management is extremely limited, but involves treating the symptoms, and if aortic dissection is suspected, then urgent transport and notification to the receiving facility is needed!

32
Q

What is a pulmonary embolism?

A

Pulmonary embolism occurs when a thrombus (or thrombi) form in one of the body’s veins (DVT) and break(s) off and enters the circulatory system. It then becomes lodged in one or more pulmonary arteries. The embolus not only prevents the exchange of oxygen and carbon dioxide in the lung, but it also decreases blood supply to the lung tissue itself, potentially causing lung tissue to infarct. Not all emboli are caused by blood clots however, and this must be taken into consideration (e.g. fat embolus, amniotic fluid embolus).

33
Q

Risk factors of a PE

A
  • Are the same as the risk factors for deep vein thrombosis
    are referred to as Virchow’s triad and include:
  • prolonged immobilisation or alterations in normal blood flow
  • hypercoagulability (e.g. birth control pills, smoking, genetic predisposition, polycythaemia, pregnancy)
  • any damage to the walls of the veins (e.g. prior deep venous thrombosis, trauma to the lower leg).
34
Q

Signs and symptoms of a PE

A
  • sudden onset of sharp chest pain that worsens with deep breathing
  • shortness of breath
  • cough (possibly with bloody sputum)
  • changes in vital signs (often an elevated heart rate and respiratory rate, decreased blood pressure and reduced oxygen saturations if clot is large enough)
  • light-headedness
  • generalised weakness
  • even cardiac arrest.
  • signs of a DVT (red, swollen calf)
  • ECG (sinus tach,
35
Q

What is GORD?

A

GORD is a condition in which the acidified liquid contents of the stomach moves up into the oesophagus.

36
Q

Signs and symptoms of uncomplicated GORD

A
  • heartburn, regurgitation and nausea.
  • People often experience an ‘indigestion’ type feeling, but often the presentation may change (or be the first presentation) and so they may think they are having a ‘heart attack’.
  • Classically a patient will say that it is a burning sensation in the centre of their chest which is worse when lying down, and is often precipitated by a spicy/acidic meal.
37
Q

Symptoms of an anxiety attack

A

symptoms may include tachycardia (can cause the chest pain), diaphoresis, headaches and muscle aches.

38
Q

Questions that can be asked in a chest pain scenario

A
  • What is the character and severity of the chest pain?
  • How has it evolved?
  • Where is the chest pain greatest and does it radiate?
  • Does the chest pain change with breathing or other movements?
  • Are there any other symptoms?
  • Is there a history of ischaemic heart disease? If ‘Yes’, is the pain similar to the usual angina or a previous MI?
  • What medications is the patient with chest pain taking? Think about how these may interact with their presentation.
39
Q

What do you do if the patient recognises the current discomfort as usual angina pain?

A

assume this is probably correct.

40
Q

Crushing, vice-like or squeezing pain is often characteristic of what condition?

A

acute coronary syndrome (ACS). Women may describe it as a feeling that their bra is really tight!

41
Q

Tearing or ripping pain is generally characteristic of what?

A

an aortic dissection.

42
Q

Sharp, well-localised pain often suggests what?

A

a pleuritic or musculoskeletal origin, but can occasionally occur with ACS or PE.

43
Q

Severe pain that is poorly relieved by large doses of pain relief suggest what?

A

a vascular catastrophe such as aortic dissection, or an oesophageal rupture.

44
Q

Pain that is described as burning is often indicative of what?

A

GORD.

45
Q

Sudden onset chest pain generally suggests what?

A

PE, aortic dissection or oesophageal rupture.

46
Q

Crescendo build-up of chest pain likely suggest what?

A

ACS.

47
Q

Onset with coughing or trauma can suggest what?

A

a pneumothorax or a mechanical cause of pain.

48
Q

Sudden chest pain following vomiting can suggest what?

A

oesophageal rupture (Boerhaave’s syndrome).

49
Q

Central, retrosternal chest pain can indicate what?

A

mediastinal or gastrointestinal origin.

50
Q

Lateral pain generally suggests what?

A

lung, pleura, chest wall or neurological referred pain.

51
Q

Radiation of the pain to the jaw, shoulders or arms is often suggestive of what?

A

ACS.

52
Q

Radiation of the pain to the back usually suggests what?

A

ACS, or thoracic aortic dissection distal to the left subclavian artery. Dissection proximal to the left subclavian artery characteristically causes non-radiating anterior chest pain.

53
Q

A burning retrosternal chest pain radiating to the neck and throat is generally suggestive of what?

A

oesophageal reflux, but ACS must always be excluded first.

54
Q

Chest pain that is worse on coughing or deep breathing often suggests what?

A

pneumothorax, rib fracture, pericarditis, PE, pneumonia, pleuritis or costochondritis.

55
Q

Chest pain that is worse on deep inspiration, when lying flat or when raising both legs (increased venous return) generally suggests what?

A

pericarditis

56
Q

Chest pain that is worse with swallowing usually suggests what?

A

an oesophageal source or pericarditis.

57
Q

Chest pain that is worse with particular movements, especially when muscular actions are resisted, suggests what?

A

musculoskeletal pain, and sometimes pneumothorax from rib injury.

58
Q

Chest pain that is made better by position may indicate what?

A

a musculoskeletal cause. Often if the patient stays still and breathes with short, shallow respirations, the pain of a rib fracture or bruise is reduced.

59
Q

If the pain is somewhat relieved by sitting up, then this often correlates with what?

A

an gastroesophageal cause.

60
Q

What is ACS more likely associated with?

A

more likely in the presence of previous ischaemic heart disease, increasing age, diabetes, hypertension, smoking or a family history of premature ischaemic heart disease.

61
Q

What conditions are Aortic dissections often associated with?

A

is often associated with chronic hypertension or connective tissue disorders such as Marfan’s or Ehlers-Danlos syndromes.

PARA2007 (15 decks)

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