Chest pain Flashcards
With a convincing history, what ECG changes would support immediate percutaneous coronary intervention?
With a convincing history, I would be concerned by ST elevation of 1mm or more in consecutive limb leads (I, II, III, aVF, aVL, aVR); or ST elevation of 2mm or more in consecutive chest leads, or new onset left bundle branch block (though some centres are now using ST elevation of 1mm in the limb leads as the criteria for PCI).
What artery supplies the sinoatrial tissue of the heart?
The right coronary artery supplies the sinoatrial nodal artery 60% of the time, the remaining 40% of the time it is supplied by the left circumflex artery.
What areas of the heart are supplied by the left anterior descending artery?
The LAD supplies the anterolateral myocardium, the apex, and the interventricular septum. Typically it supplies up to 55% of the left ventricle.
What is the differential diagnosis of chest pain?
Cardiac: ACS, aortic dissection, pericarditis, myocarditis
Respiratory: PE, pneumonia, pneumothorax, pleurisy, cancer
Other: musculoskeletal, panic attack, costochondritis, GORD, oesophageal spasm
How might you differentiate the pain of an MI from pericarditis on history?
MI: central crushing pain which can radiate to arm and jaw; associated N&V, SOB, sweating; cardiovascular risk factors
Pericarditis: retrosternal/precordial pleuritic chest pain which can radiate to the trapezius ridge/neck/shoulder; better when sitting forward; often has a viral prodrome.
What are the immediate and later complications of myocardial infarction?
Immediate: Ventricular arrhythmias, death, bradyarrhythmias/heart block, cardiogenic shock,
Later: Stroke, another MI, cardiac tamponade, pericarditis, valve disease, heart failure, embolism, mitral regurgitation
