15 Chest Pain and Acute Coronary Syndrome Flashcards
(19 cards)
What does SQITARS stand for?
Site Quality Intensity Time Aggravating Factors Relieving Factors Secondary Symptoms
What may cause chest pain (in general terms)?
1- MSK+Skin: e.g. Shingles, costochondritis, rib fracture 2-Lungs and Pleura: e.g. Pneumonia, pulmonary embolism 3-Heart 4- Aorta: e.g. Aortic Dissection 5- Oesophagus: e.g. Acid Reflux (burning), peptic ulcer disease
What characterises pleuritic chest pain?
- Well localised
- Worse on inspiration+coughing
- Stabbing/burning sensation
What would distinguish MSK/skin causes of chest pain from others?
Tenderness to palpate
What is ‘aortic dissection’?
Wall of aorta splits. Sharp, tearing pain- radiating to back
Is the cardiac tissue is affected, how might the pain be described?
-Dull/crushing -Poorly localised -radiating to shoulder/jaw/arm
What is pericarditis?
Inflammation of pericardium (often secondary- Viral Illness)
How would someone with pericarditis present?
- Retrosternal
- Sharp pain, localised- front of chest
- Pain eased on sitting up
- Pain aggravated w./ inspiration, cough, lying (as attached to diaphragm)
What is Ischaemic Heart Disease?
Pain secondary to pathology involving the heart (same risk factors as atherosclerosis)
If a patient has stable angina, how will they present?
-History- chest pain when exercising -No chest pain at rest -GTN spray (vasodilator) may relieve pain
Why does a patient with stable angina usually not present with pain at rest?
Heart tissue ischaemia only occurs when metabolic demands= greater than what can be delivered e.g. on exertion
What classifies as an ‘Acute Coronary Syndrome’?
1=Unstable Angina 2=Myocardial Infarction a-NSTEMI b-STEMI
What is Acute Coronary Syndrome?
Acute myocardial ischaemia- due to atherosclerotic coronary artery disease
Describe the process causing Acute Coronary Syndrome.
1- Plaque ruptures 2- Thrombus formation 3-Acute increased occlusion 4-Ischaemia then potential infarction
How would a patient with Unstable Angina present?
Similar to stable angina + -Pain at rest -Pain more intense -Pain last longer -Autonomic response e.g. sweating, nausea (can progress to MI)
How would a patient experiencing an MI present?
Similar to Unstable Angina
+
- More severe autonomic response
- Pulse rate increase
How do you differentiate between a STEMI and UA/NSTEMI on an ECG?
(st segment and t wave)
ST segment elevation=STEMI
ST segment depression=UA/NSTEMI
Hyperacute T-wave= STEMI
Flattened/inverted T-wave= UA/NSTEMI
What changes on a normal ECG are suggestive of ischaemia or infarct?
-ST segment elevation/depression -T waves widespread/inverted - Pathological Q-waves
How would you differentiate between Unstable Angina and NSTEMI?
Blood test: rise in troponin if infarcted
