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Baz: Semester 2 > KCP: Chest Pain 2 > Flashcards

KCP: Chest Pain 2 Flashcards

Electric Boogaloo

1
Q

4 common respiritory causes of chest pain?

A
  1. Pulmonary Embolus
  2. Pneunomia
  3. Pneumothorax
  4. Pleurisy
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2
Q

What is Pleurisy?

A

Also known as pleuritis.

Inflamation of the plaura.

Presentation is sharp pain during inspiration.

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3
Q

5 common gastrointestinal causes of chest pain?

A
  1. Oesophageal reflux
  2. Peptic ulcer
  3. Pancreatitis
  4. Gallstones
  5. Paraesophageal hiatus hernia
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4
Q

Signs that chest pain is a gastrointestinal cause?

A
  • The pain is related to eating
  • Worse when lying down
  • Indigestion/ heartburn
  • Epigastric pain - pain or discomfort below the ribs in your upper abdomen area
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5
Q

4 common musculoskeletal causes of chest pain

A

Muscle strain
Rib fracture
Costochondritis
Myositis

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6
Q

Signs that chest pain has a musculoskelletal cause?

A
  • Provoking event
  • Worse with movement
  • Worse with breathing
  • Tender points
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7
Q

3 common causes of neurological chest pain

A
  • Neuropathic pain
  • Shingles
  • Anxiety
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8
Q

Sign it could be shingles?

A

Follows a dermatological pattern

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9
Q

Sign it could be another neurological cause?

A
  • Recurrent admissions, previous exclusion of underlying pathology
  • Related psychiatric symptoms
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10
Q

4 commonc ardiovascular causes of chest pain

A
  1. Ischaemic heart disease
  2. Pericarditis
  3. Aortic dissection
  4. Myocarditis
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11
Q

One for silly Baz:

What do you call a mini-stroke vs mini-heart attack (always get these mixed up)

A
  • Mini stroke - transient incheamic attack TIA
  • Mini heart attack - Angina
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12
Q

6 Angina presentations

A
  • A mis-match between oxygen supply and delivery
  • Exertional pain/tightness/discomfort
  • Location: central chest/radiate to throat/arm/back
  • relieved by resting
  • Relieved by sublingual glyceryl trinitrate (GTN) sublingual spray
  • Often worse in cold weather/walking into the wind
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13
Q

4 blood tests you do with suspected angina?

A
  • Full blood count - PO2 could be low so this is to exclude anaemia due to low heamoglobin
  • Urea and electrolytes - Normal renal function
  • Lipids - risk factor
  • Glucose, haemoglobin A1c - to exclude Diabetes
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14
Q

What is low peripheral pulses – neck, arms, legs, feet - a sign of

A

Angina

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15
Q

ECG and angina?

A

An ECG can often miss an angina

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16
Q

First line diagnostic investigation for an angina?

A

CT coronary angiography. This is a CT of the heart and it’s arterial blood supply

17
Q

This is a normal CT-Coronary angiography. What would be different if angina is indicated?

A
18
Q

What is stenosis?

A

Stenosis means narrowing

19
Q

Lifestyle intervention for Angina

A

Stop smoking
Weight loss
Exercise
Diet- Mediteranean

20
Q

Drug for symptomatic relief duirng anginal episode?

A

Sub-lingual GTN spray.

GTN is a vasodilator

21
Q

What is GTN?

A

glyceryl trinitrate (GTN)

22
Q

What is Atorvastatin used for?

A

Reduces cholesterol

23
Q

What are ACE inhibitors/Angiotensin receptor blockers used for?

A

Use to treat blood pressure

24
Q

What are Calcium channel antagonists used for?

A

Vasodialation

25
Q

How do Beta-Blockers help with an angina?

A

Slows the heart rate, reduced myocardial O2 demands

26
Q

How does aspirin help with angina?

A

It is an antiplatelet

27
Q

6 grug treatments for an Angina

A
  • Sub-lingual GTN spray for symptomatic relief during an anginal episode
  • Aspirin (antiplatelet)
  • Beta-blockers (slows the heart rate, reduced myocardial O2 demands)
  • Calcium channel antagonists (coronary vasodilator)
  • Atorvastatin (reduces cholesterol)
  • ACE inhibitor/Angiotensin receptor blocker (for blood pressure)
28
Q

What is acute coronary syndrome?

A

This covers any problem form acute lack of blood supply to the heart. Covers unstable angina through to myocardial infarction

29
Q

When refering to the ECG what defines a STEMI?

A

Definition - ST elevation in 2 contiguous leads:
≥ 2.5mm in V2-V3 in men <40 years old
≥ 2mm in V2-V3 in men ≥40 years old
≥ 1.5mm in V2-V3 in women
≥ 1mm in all other leads

Hint - V2 and V3 heart attacks for you and me
30
Q

Two types of NSTEMI

A
  • ST Depression (>0.5 mm in two anatomically contiguous leads)
  • T wave inversion (in two anatomically contiguous leads)
31
Q

Semester 1 recap: Troponin

A

Found in raises levels in the blood and is an indicator of myocardial cell death

32
Q

What is percutaneous coronary intervention (PCI)?

A

This is a non surgical procedure that uses a catheter in order to place a small structure (stent) inside the vessels to the heart in order to keep them open

33
Q

Other cause of chest pain: Pericarditis. What is it?

A

Inflamation of the pericardium which is the membrane surrounding the heart

34
Q

What causes pericarditis?

A

Can be common after infections such as pneumonia or Covid.

However can also occur post myocardial infarction or cardiac surgery

35
Q

Signs of pericarditis?

A
  • Chest pain releived by sitting forward
  • Can be worse when lungs are inspired
  • ECG can show Widespread ST segment elevation (concave upwards) along with PR depression

However key is that they are young and not at risk of any cardiac disease

36
Q

What is an aortic dissection?

A

Occurs when there is a dissection of blood into the wall of the aorta.

This occludes arterial branchs including coronary arteries

If it ruptures into the pericardium can cause cardiac tamponade (pressure on heart)

37
Q

Who is at risk of an aortic dissection?

A

Young patients with a family history of aortic dissection/Marfan syndrome/Ehlers Danlos syndrome

Older patients with Hypertension

38
Q

When can a Q wave be pathological?

A

> 40 ms (1 mm) wide
2 mm deep
25% of depth of QRS complex
Seen in leads V1-3

The key is that they are wide and deep and show in V1-3 (same as ST elevation). This occurs during myocardial infarction and persists forever, so Q wave without ST elevation can be a sign that someone has previously had a myocardial infarct

Baz: Semester 2 (42 decks)

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