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Year 3 - MedEd Lectures > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

What is Stable Angina?

A

Chest Pain resulting from Myocardial Ischaemia that is precipitated by exertion and relieved by rest.

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2
Q

What is Decubitus Angina?

A

Symptoms of angina that occur when lying down.

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3
Q

What is Prinzmetal Angina?

A

Symptoms of Angina caused by Coronary Vasospasm.

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4
Q

What is Coronary Syndrome X?

A

Symptoms of Angina

Normal Exercise Tolerance

Normal Coronary Angiograms

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5
Q

How should you manage a case of Stable Angina?

A

Conservative - Stop smoking, lose weight, exercise

Medical - Anti-Anginals (BB/CCB), GTN Spray, risk factor reduction (aspirin, statins, ACEi)

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6
Q

Define Acute Coronary Syndrome.

A

A collection of symptoms caused by sudden reduced blood flow to the heart.

STEMI

NSTEMI

Unstable Angina

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7
Q

What is Unstable Angina?

A

Chest pain at rest due to ischaemia without Cardiac Injury (Normal Troponin)

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8
Q

How does ACS present?

A

Acute-onset, central, crushing chest pain.

Radiates to the arms/neck/jaw

Pallow

Sweating

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9
Q

How do you investigate suspected ACS?

A

ECG

Troponin

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10
Q

How would you use an ECG to diagnosis ACS?

A

STEMI

Hyperacute T Waves

ST Elevation

New-onset LBBB

NSTEMI/Unstable Angina

ST Depression

T Wave Inversion

Heart Block

AV Node involvement

Old Infarction

Pathological Q Waves

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11
Q

Which artery is occluded in a STEMI showing ST elevation in leads II, III and AVF?

A

Right Coronary Artery

Inferior STEMI

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12
Q

Which artery is likely occluded in a STEMI showing ST Elevation in leads V1-V5?

A

Left Anterior Descending

Anterior

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13
Q

Which artery is likely occluded in a STEMI showing ST Elevation in leads I, aVL, V5/6?

A

Left Circumflex

Lateral

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14
Q

Which artery is likely occluded in a STEMI showing ST Elevation and tall R waves in V1-3?

A

Posterior Descending

Posterior

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15
Q

How do you manage a patient with ACS?

A

Morphine

Oxygen

Nitrates

Antiplatelets (Aspirin & Clopidogrel)

Beta-Blockers

ACE Inhibitors

Statins

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16
Q

How would you manage a patient with a confirmed STEMI?

A

<12 Hours - PCI

>12 Hours - Coronary Angiography (Followed by PCI if indicated)

17
Q

How would you manage a patient with NSTEMI/Unstable Angina?

A

Aspirin & Clopidogrel

Fondaparinux - if there is a low, bleeding risk

Unfractionated Heparin (If planned angiography)

Risk Stratify using GRACE Score

High Risk - GlpIIb/IIIa Inhibitor (tirofiban)

Low Risk - Conservative Management

18
Q

What are the Complications of ACS?

A

DARTH VADER

Death

Arrhythmia

Rupture

Tamponade

Heart Failure

Valve Disease

Aneurysm

Dressler’s Syndrome

Embolism

Reinfarction

19
Q

What is the difference between anticoagulants and antiplatelets?

A

Anticoagulants (eg. warfarin) block the activation of coagulation factors, and tend to be used in the treatment of Venous Thromboembolism.

Antiplatelets block platelet activation and tend to be used to treat Arterial Thromboembolism.

20
Q

What are the causes of Pericarditis?

A

Idiopathic

Infective (Coxsackie B)

CTDs (eg. Sarcoidosis)

Dressley Syndrome (2-10 Weeks Post-MI)

Malignancy

21
Q

How does Pericarditis present?

A

Shar, central chest pain

Pleuritic in nature

Relieved by sitting forward

Fever (if viral)

Pericardial Rub

Tamponade

Wide-spread saddle-shaped ST Elevation on ECG

22
Q

How does symptomatic Atrial Fibrillation present?

A

Palpitations

Syncope

Symptoms of underlying cause (Loads)

Irregularly irregular pulse

23
Q

How would you manage a patient with AF?

A

Haemodynamically Unstable - DC Cardioversion

Rhythm Control <48 Hours

DC Cardioversion or chemical Cardioversion (flecainide [contraindicated if Hx IHD] or amiodarone)

Rhythm Control >48 Hours

Anticogulate for 3-4 weeks then DC Cardioversion

Rate Control

Verapamil

Beta-Blockers

Digoxin

High-Risk Cha2DS2-VASC? Warfarin

24
Q

What is a Supraventricular Tachycardia?

A

Regular, narrow-complex tachycardia with no p waves and a supraventricular origin.

AVNRT or AVRT

25
Q

How would you investigate a suspected SVT?

A

ECG

Regular, narrow complex tachycardia, absent P-Waves

Delta Wave = Wolf-Parkinson-White AVRT

26
Q

How would you manage a case of SVT where the patient is Haemodynamically Unstable?

A

Synchronised DC Cardioversion

27
Q

How would you manage a Haemodynamically Stable patient with an SVT?

A

1) Vagal Manoeuvres
2) Adenosine IV
3) IV BB/ Amiodarone/ Digoxin

28
Q

How would you manage a haemodynamically stable patient with an SVT and asthma, when Vagal Manoeuvres are unsuccessful?

A

Verapamil

Adenosine is contraindicated in asthma

29
Q

What would be your Cardiac Ddx in a patient presenting with Syncope?

A

Vasovagal

Arrhythmia

Outflow Obstruction (HOCM, Aortic Stenosis_

Postural Hypotension

30
Q

What are the clinical features of HOCM?

A

Jerky Carotid Pulse

Double Apex Beat

Ejection Systolic Murmur

FHx of young, sudden death

Year 3 - MedEd Lectures (29 decks)

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