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Year 3 MedEd slides > Chest pain > Flashcards

Chest pain Flashcards

1
Q

Name 3 rare causes of angina

A

Decubitus angina
Prinzmental angina
Coronary syndrome X

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2
Q

What is decubitus angina?

A

Angina when lying down brings on symptoms

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3
Q

What is prinzmental angina?

A

Symptoms caused by coronary vasospasm

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4
Q

What is coronary syndrome X?

A

Symptoms of angina but with NORMAL exercise tolerance and normal coronary angiograms

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5
Q

What is the difference between unstable angina and an MI?

A

There is NO cardiac injury in angina

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6
Q

In which sort of people might the acute coronary syndrome be silent/ asymptomatic?

A

Diabetics and the elderly

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7
Q

Recall 3 ECG features of a STEMI

A

Hyperacute T waves
ST elevation
New LBBB

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8
Q

Recall 2 ECG features of unstable angina/ NSTEMI

A

Inverted T waves

ST depression

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9
Q

Recall which coronary artery supplies each portion of the heart

A

Inferior: right coronary artery
Anterior: LAD
Lateral: left circumflex
Posterior: posterior descending

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10
Q

In which leads is the ECG affected in an inferior infarct?

A

II, III, aVF

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11
Q

In which leads is the ECG affected in an anterior infarct?

A

V1-V5

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12
Q

In which leads is the ECG affected in a lateral infarct?

A

I, aVL, V5/6

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13
Q

In which leads is the ECG affected in a posterior infarct?

A

V1-3

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14
Q

What would be seen on ECG in a posterior infarct specifically?

A

Tall R waves and ST depression in leads V1-3

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15
Q

Recall the mnemonic for and the management plan of the acute coronary syndrome

A 
MONARCH
Morphine
Oxygen
Nitrates (GTN)
Aspirin
Revascularisation (PCI)
Clopidogrel
Heparin (LMWH)
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16
Q

Within how many hours of onset of symptoms of the ACS can PCI be performed?

A

4.5

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17
Q

Recall the mnemonic for and the complications of ACS

A 
DARTH VADER
Death
Arrhythmia
Rupture
Tamponade
Heart failure
Valve disease
Aneurysm
Dressler's syndrome
Embolism
Reinfarction
18
Q

Why is warfarin not given in the acute setting for MI?

A

It has an initial procoagulative effect because it blocks proteins C + S

19
Q

What is Dressler’s syndrome?

A

Pericarditis that presents 2-10 weeks post-MI

20
Q

What is the first line of treatment for cardiac tamponade?

A

Pericardiocentesis

21
Q

What is Beck’s triad?

A

Triad of signs indicating cardiac tamponade

22
Q

Recall the elements of Beck’s triad?

A

Muffled heart sounds
Raised JVP
Low BP

23
Q

What is heard upon auscultation in pericarditis?

A

Pericardial friction rub

24
Q

What is the characteristic ECG finding in pericarditis?

A

Widespread saddle-shaped ST elevation

25
Q

What is Tietze syndrome?

A

A rare inflammatory disorder characterised by chest pain and swelling of the cartilage of one or more of the upper ribs (costochondral junction), specifically where the ribs attach to the sternum.

26
Q

When should DC cardioversion be performed in atrial fibrillation?

A

If patient is haemodynamically unstable

27
Q

Differentiate how you would control rhythm in a patient with AF <48 hours and >48 hours since onset of symptoms

A

<48hrs: DC cardioversion or cheical cardioversion with flecainide/ amiodarone

> 48 hours: anticoagulate for 3-4 weeks before attempting cardioversion

28
Q

Recall the anti-coagulant drug of choice for patients of low and high CHA2DS2-Vasc scores

A

Low risk: aspirin/ none

High risk: warfarin

29
Q

What CHA2DS2-Vasc score indicates anti-coagulation therapy should be started?

A

> 1

30
Q

Recall 3 drugs that may be used in rate control for AF

A

Verapamil
Beta blockers
Digoxin

31
Q

Recall 2 ECG features of SVT

A

No p waves

Narrow-complex

32
Q

Recall 3 symptoms of SVT

A

Palpitations
Syncope
Dyspnoea

33
Q

What is the name of the accessory pathway present in AVRT?

A

Bundle of Kent

34
Q

What ECG change is indicative of Wolff-Parkinson-White syndrome?

A

Delta waves

35
Q

What is the first line of management in a haemodynamically unstable SVT patient?

A

Synchronised DC cardioversion

36
Q

What is the first line of management in a haemodynamically stable SVT presentation?

A

Vagal manoevres

37
Q

Recall the incrementally increasing dose of adenosine that can be given to chemically cardiovert

A

6mg
12mg
12mg

38
Q

Recall 2 vagal manoevres

A

Carotid body massage

Blowing against a syringe

39
Q

Give one reason why adenosine may be contra-indicated, and an alternative drug that could be used

A

Asthma

Verapamil

40
Q

Recall 4 key clinical features of hypertrophic obstructive cardiomyopathy

A

Jerky carotid pulse
Double apex beat
Ejection systolic murmur
FHx of sudden death at <65 y/o

41
Q

How should a true hyperkalaemia be treated?

A

10mL 10% calcium gluconate

42
Q

Why might a blood test reveal a false hyperkalaemia?

A

If blood is drawn too quickly –> red cell lysis –> K+ release

Year 3 MedEd slides (16 decks)

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