Anatomy - Differential Diagnosis of Central Chest Pain

Question 1

How do sympathetic signals travel from the brain to the organ?

Answer 1

Travels down the spinal cord and exits between T1-L2/3 into the sympathetic chain where it has 5 different options to synapse and then travels to the organ. Slide 4

Question 2

What are the cardiopulmoanry splanchnic nerves?

Answer 2

The Sympathetic nerves that supply the heart and the lungs. Slide 5

Question 3

What makes up the cardiac plexus?

Answer 3

Sympathetic fibres
Parasympathetic fibres
Visceral afferent fibres. Slide 6

Question 4

How do the parasympathetic signals reach the organs?

Answer 4

Through cranial nerves III, VII, IX and X.

The first 4 cranial nerves synapse in the head and the last synapses in the walls of the organs. Slide 8

Question 5

If someone has somatic pain what would it be described as and what could give rise to it?

Answer 5

Typically sharp and stabbing nature. Usually well localised.
E.g. musclular, joint, bony pains. Slide 10

Question 6

If someone had visceral pain what would the pain be described as and what organs could cause this pain?

Answer 6

Dull, aching pain. Often nauseas and poorly localised.

E.g. oesophagus, heart, trachea and abdominal viscerae. Slide 10

Question 7

Where is the somatosensory cortex of the brain?

Answer 7

Postcentral gyrus of the parietal lobe.

Brings the sensations into consciousness. Slide 12

Question 8

What is the sensory homunculus?

Answer 8

The illustration of the areas of the cerebral neocortex which shows where the different sensations of the body reach consciousness. Slide 13

Question 9

WHat are examples of diseases that can cause central sharp chest pain?

Answer 9

If shingles occurs on the T4/5 dermatome
Msucle, joint pain e.g. msucle strain, joint inflammation
Parietal pleura and pericardium e.g. pleurisy and pericarditis. Slide 14

Question 10

What anatomical features can be seen on the right and left side of the mediastinum?

Answer 10

Right:
Phrenic nerve, vagus nerve on trachea, trachea, SVC, azygous veins, oesophagus.
Left:
Phrenic nerve, vagus nerve over arch of aorta, the thoracic duct, ligamentum arteriosum. Slide 17+18

Question 11

Where do visceral afferents travel through?

Answer 11

Enter the spinal cord and pass bilaterally to the thalamus and hypothalamus and then diffuse into the cortex. Slide 20

Question 12

What is radiating pain?

Answer 12

Pain which is felt in the area of tissue damage and spreads around it to another area. Slide 21

Question 13

What is referred pain?

Answer 13

Pain only felt in an area that is away from the area of tissue damage. Slide 22

Question 14

There are 3 types of heart attacks, what are they?

Answer 14

Inferior MI
Anterolateral MI
Anterior MI. Slide 23

Question 15

Which coronary artery is dominant in 70% of patients?

Answer 15

The right coronary artery. Slide 25

Question 16

In the order of most common to the least common, what are the sites of coronary atherosclerosis?

Answer 16

1. Anterior interventricular artery.
2. Right coronary artery
3. Circumflex branch.
4. Left coronary artery. Slide 26

Question 17

What is CABG and how do they do it?

Answer 17

Coronary artery bypass graft
They take a graft vessel e.g. from radial artery, internal thoracic artery etc.
And attach it proximal to the site of obstruction on the ascending aorta and then attach it distal to the site of obstruction. Slide 27 .

Question 18

What is the blodo supply for the SA node and the AV node?

Answer 18

SA nodal branch from the right coronary artery.

Av nodal branch from the right coronary artery near the posterior interventricular artery. Slide 28

Question 19

What is the arterial blood supply for the interventricular septum?

Answer 19

The left anterior descending artery and the posterior interventricular artery. Slide 29