Chest Pain

Question 1

What 5 things should you always report on an ECG?

Answer 1

rate, regularity, QRS morphology, presence of P waves, relationship of P waves to QRS complexes

Question 2

What 5 things should you clarify/do before you raise the alarm for ACS?

Answer 2

onset of symptoms, location/nature of symptoms, context which you found the patient in, ECG, compare to old ECG

Question 3

What is the first step in the chest pain pathway?

Answer 3

do an ECG and order troponins within 10 minutes of presentation

Question 4

What is the definition of a STEMI?

Answer 4

clinical symptoms consistent with ACS with the ECG changes of ST elevation of >1mm in limb leads or >2mm in precordial leads in 2 or more contiguous leads (or new LBBB?)

Question 5

What are high risk features that would make the patient high risk for ACS even if it is not a STEMI?

Answer 5

ongoing or worsening pain
syncope or sustained VT
previous AMI, CABG or PCI
known left ventricular systolic dysfunction
haemodynamic compromise
new ischaemic ECG changes
elevated initial troponin

Question 6

What are the elements of the TIMI score?

Answer 6

age > 65
> 3 risk factors for IHD (FHx, HTN, cholesterol, diabetes, current smoker)
aspirin use in last 7 days
recent severe angina
elevated troponin
ST elevation >0.5mm
previous coronary stenosis > 50%

Question 7

What other blood tests should be ordered for chest pain apart from troponin?

Answer 7

FBE, UEC and blood glucose

Question 8

What treatment should be given to chest pain patients?

Answer 8

aspirin 300mg, sublingual GTN, oxygen to maintain sats over 93%, possible morphine