1 - Chest pain Flashcards by Mark Brown

What conditions are included in acute cornary syndrome?

Unstable angina, Non-STEMI, STEMI

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Sudden onset of chest pain indicates…

Pulmonary embolism

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Feeling of “severe ripping” radiating between the scapulars indicates…

Aortic dissection

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Where does chest pain relating to ACS refer to?

Left arm, neck and jaw

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What is angina (pectoralis)?

Discomfort of the chest and adjacent areas caused by myocardial ischaemia.

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What is typical angina?

All 3 of: - discomfort in chest or neck, shoulder, jaw , arm - precipitated by physical exertion - relieved by GTN after 5 minutes

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What is atypical angina?

2 of: - discomfort in chest or neck, shoulder, jaw , arm - precipitated by physical exertion - relieved by GTN after 5 minutes

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Risk factors for coronary artery disease (same for peripheral artery disease)?

Age - Gender - Diabetes - hyperlipidemia - smoking - hypertension

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Describe an aortic stenosis murmur

Ejection systolic - crescendo-decrescendo - left sternal edge, 2nd intercostal - refers to carotid

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Describe a mitral regurgitation murmur

Pan systolic - constant through s1 to s2 - radiates to axilla

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Describe a mitral stenosis murur

mid diastolic - though to s2 - apex with patient in left lateral position

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Describe an aortic regurgitation

Early diastolic - diminuendo from S2 - left sternal edge 4th intercostal

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MI affecting of papillary muscle leads too…

mitral regurgitation –> atrial dilation –> pulmonary hypertension –> pulmonary oedema –> crackle upon auscultation Atrial dilation can also lead to atrial fibrillation

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What are the consequences of myocardial infarction?

Decreased contractility - Hypotension –> worsening ischaemia - blood stasis –> embolism Electrical instability - Arrythmias Necrosis - mitral/ tricuspid regurgitation - cardiac tamponade (heamoperricardium) - ventricular septal defect

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What is the management of suspected ACS?

300mg of aspirin - 12 lead ECG - Blood test: Troponins

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How to diagnosing myocardial infarction.

raised troponin - + 1 more of: - symptoms of ischaemia - thrombus in angiogram - echo of infarct - pathological Q wave - ST changes

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What scoring system is used for Ischaemic risk?

GRACE

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What scoring system is used for bleeding risk?

CRUSADE

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What does RILE stand for in relation to heart murmurs

Right - Inspiration - Left - Expiration

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MI can lead to papillary muscle dysfunction causing the pathology of which murmur?

mitral regurgitation This leads to left atrial dilation (atrial fibrillation) and therefore pulmonary hypertension and therefore pulmonary oedema.

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What is the most common pathology of a ejection systolic murmur?

Calcification of the aortic valve leading to aortic stenosis

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ROMANCE

R - eassurance O - xygen M - orphine A - sprin N - nitrates C - lopidogrel (tricargelor) E - CG

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MONC

M - orphine O - xygen N - itrates C - opidogrel

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Treatment for STEMI/NSTEMI

PCI from 12 hours of onset and within 120 mins of admission, otherwise fibrinolysis.

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Which is most common NSTEMI or STEMI?

NSTEMI

What indicates a STEMI on ECG?

- ST elevation - peaked T waves followed by inverted T waves - new Q waves

Indication to call ambulance after using GTN:

- try 2 twice - wait 5 mins - after 15 mins call ambulance

What other causes of MI are there apart from artery occlusion?

- Aortic stenosis - Hypertrophic Cardiomyopathy (HOCM) - Tachyarrythmias - Cocaine use - Anaemia -Thyrotoxicosis

What is the long term management of ACS?

- aspirin for lyfe - DAPT for 12 months - statins - \< 40% LVEF then add ACEi and B-blocker

Patient has chest pain with no ST elevation on ECG however has a marked increase in troponin. What is the diagnosis?

NSTEMI

ΔΔ PE

- sudden onset pleuritic pain - associations: fever, SoB and haemoptysis - may notice unilateral swollen, hot, tender leg

What is pleuritic pain?

Pain made worse by inspiration

What diagnosis have pleuritic pain?

- PE - pneumonia - tension pneumothorax - pericarditis

ΔΔ GORD

- burning sensation - worse when lying down, after eating, leaning forwards - sour taste in mouth - relieved by swallowing and water.

ΔΔ pericarditis

- relieved by leaning forward - worse when lying down

What is a thrill?

A palpable murmur

What risk factors included for clotting/ PE?

- pregnancy - stasis -previous clotting event - smoking - surgery - malignancy - Varicous veins - DVT

1st degree heart block

PR interval \> 0.22

Mobitz type 1

- 2nd degree heart block - progressively longer PR interval

Mobitz type 2

- 2nd degree heart block - intermittent conduction of P waves

3rd degree heart block

- no condition of P waves

Right bundle branch blocks

MaRRoW QRS pattern: - M in V1 - W in V6

Left bundle branch block

WiLLiam QRS pattern: - W = V1 - M = V6

Reporting a ECG

- Rythmn - Conduction interval - Cardiac axis - QRS complex - ST and T waves

Normal PR interval

0.12 - 0.22s

Normal QRS

\< 0.12s

normal QT interval

around 0.4s

Inferior ECG leads

- III - aVF Right coronary artery

Lateral ECG leads

- I - II - aVL Left circumflex

Anteriorlateral ECG leads

- V4-6 - I -aVL left circumflex

Anetior septal

- V1-4 LAD

Posterior

- Tall T waves in V1-2 Right coronary and left circumflex

How do T waves change from the time the MI occurs

- early T waves are peaked - T waves become inverted

Where is Q wave most prominent?

V6 - left ventricle depolarises first

Characteristics of QRS in V1

- no Q wave - R wave should be prominent

Transitional point of an ECG

Deviation of the Q and R waves should be equal from the isoelectric point. Should be in V3-4. Indicates cardiac axis deviate

ECG features of AF?

- no P waves - irregular QRS activation - normal chape QRS

ECG features of ventricular fibrillation?

- no discernible QRS pattern

ECG features of ventricular tachycardia?

- no P waves - QRS are frequent and broad - no T waves

ECG features of supra ventricular tachycardia?

- many P waves - NOT sinus rhythm

How can carotid massage stop supraventricular tachycardias?

Stimulates vaso-vagal responce to slow the heart rate

In normal ECGs where can T waves be inverted?

- aVR - V1

Which mumur is related to a narrow pulse pressure which is slow rising?

Aortic stenosis

Which mumur is related to a wide puse pressure and a collapsing pulse?

Aortic reurgitation

Apart from GTN, what is 1st line management for angina?

ß-blocker or CCB

What is the second line for management of angina?

ß-blocker and a CCB

When a patient is suffering from angina with heart failure what is the recommended 1st line therapy?

Atenolol

1 - Chest pain Flashcards

(68 cards)