Central Chest Pain Flashcards
(36 cards)
What is atherosclerosis?
A chronic inflammatory process triggered by the accumulation of cholesterol-containing low-density lipoprotein (LDL) particles in the arterial wall.
When does coronary blood flow predominantly occur?
During diastole – when the myocardium is relaxed and the smaller coronary vessels penetrating through the muscle layers to take blood to the deeper layers of the myocardium are not squeezed by the contracting myocardium.
Name the key branches of the right and left main coronary vessels. (5)
Right - right marginal and posterior descending
Left - left anterior descending, left marginal and left circumflex
What is the coronary sinus?
A collection of veins joined together on the posterior side of the heart to form a large vessel that collects deoxygenated blood from the myocardium of the heart and delivers it to the right atrium.
What are the main symptoms and signs of thoracic aortic dissection? (4)
Sudden, tearing pain radiating to back.
Syncope
Stroke
Leg ischaemia
What are the main signs indicative of thoracic aortic dissection? (2)
Pulsus paradoxus
Difference in BP in both arms.
What is pulsus paradoxus?
An exaggerated fall in the patient’s blood pressure greater than 10mmHg during inspiration.
What type of pain is typically experienced in pericarditis?
Constant or intermittent sharp pain, often aggravated by breathing or position (classically worse on lying down and relieved by sitting or leaning forward).
What signs are indicative of acute coronary syndrome (ACT)? (4)
Sinus tachycardia
Xanthelasma
Tar staining on fingers
A new pansystolic murmur (mitral regurgitation)
What three types of coronary disease does acute coronary syndrome (ACS) refer to?
Unstable angina
Non-ST-elevation MI
ST-elevation MI
What are the main symptoms of myocarditis? (5)
Fever
Dyspnoea
Fatigue
Chest pain (if myopericarditis) which may be pleuritic
Recent viral or other infection
What type of pain is indicative of oesophageal rupture?
Sudden, severe pain following vomiting or instrumentation.
What group of symptoms are indicative of pancreatitis, gallstones/cholecystitis or hepatitis? (3)
Pain in epigastrium or lower chest, often worse when lying flat and relieved by leaning forward
Vomiting
Upper abdominal tenderness
What are the three main symptoms of shingles?
Sharp, band-like pain in the thorax unilaterally
Classic linear, vesicular rash
Pain may precede rash by several days
In which ECG leads is it acceptable to have T wave inversion?
aVR, V1 and lead III
What changes on an ECG should be considered suspicious for coronary artery disease? (4)
-ST segment elevation/depression
-T wave abnormalities (hyperacute T-waves or T-wave inversion)
-Pathological Q waves (abnormal width or depth, or seen in leads V1-3)
-Left bundle branch block (LBBB –> broad QRS, deep S wave in V1 and no Q wave in V5/6)
What three clear diagnostic features do the NICE guidelines provide for typical angina chest pain?
Constricting discomfort in front of chest, neck, shoulders and arms.
Pain precipitated by physical exertion
Pain relieved by GTN or rest in about 5 minutes.
What is the pathophysiology of stable angina?
Narrowing of the coronary artery lumen means that at rest there is no chest pain, but during exertion myocardial demand rises, and supply cannot meet this demand, resulting in exertional chest pain relieved by rest or GTN.
What is coronary artery disease (CAD)?
Atherosclerosis and atheroma formation results in progressive narrowing of the lumen in a coronary artery.
Briefly describe the pathophysiology of acute coronary syndrome (ACS).
An unstable plaque can rupture, resulting in platelet aggregation and thrombus formation which can cause sudden occlusion of the coronary artery, resulting in acute chest pain.
What are the subtypes of acute coronary syndrome (ACS) dictated by?
The degree and duration of occlusion of the coronary artery:
-STEMI = total and persistent occlusion.
-NSTEMI/unstable angina = partial or temporary occlusion.
What should be the next investigation for somebody who has had acute chest pain lasting more than 15 minutes, and does not have ST elevation on ECG?
6 hour troponin test - normal levels 6 hours after pain onset excludes MI, whilst elevated levels indicate NSTEMI.
What is the name of the tool used in General Practice to determine somebody’s cardiovascular risk?
QRISK3 score - score which establishes patient’s 10 year risk of cardiovascular events.
What advice should you give a patient with coronary artery disease (CAD) for when they have an episode of chest pain? (4)
Stop what they are doing and rest
Use GTN spray as instructed (single puff once seated)
Take a second dose of GTN after five minutes if pain persists
Call 999 if pain persists for 15 minutes despite use of sublingual GTN, or earlier if pain is intensifying or you feel unwell.
