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Chest pain Flashcards

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1
Q

What is a differential for ST elevation in inferior ECG leads?

A

Aortic dissection

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2
Q

Which syndromes are associated with aortic dissection?

A

Marfan’s
Ehlers-Danlos
Turner’s
Noonan’s

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3
Q

Risk factors for aortic dissection?

A 
Hypertension
Trauma
Pregnancy
Bicuspid aortic valve
Syndromes (M, E, T, N)
Syphilis
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4
Q

Features of aortic dissection?

A

Tearing pain
Hyper or hypotensive depending on blood loss
Tachycardia, clammy and cold
Artery specific involvement
No / non-specific ECG changes / ST elevation in inferior leads

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5
Q

Associated symptoms of reflux?

A

Vomiting
High BMI
Positional changes in pain - worse when lying

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6
Q

Presentation of infective endocarditis?

A

Fever
Murmur
IV drug use is a risk factor

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7
Q

What organism is most likely to cause infective endocarditis in an IV drug user?

A

S. aureus

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8
Q

Risk factors for PE?

A 
Immobility / surgery
Previous PE
History of malignancy
Tachycardia
Haemoptysis
Signs of DVT
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9
Q

Dressler’s syndrome is…

A

Auto-immune pericarditis occurring 2-6 weeks after an MI

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10
Q

Presentation of Dressler’s syndrome?

A

Pleuritic chest pain
Pyrexia
Rubbing sound on auscultation
Pansystolic murmur

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11
Q

Treatments for chronic heart failure?

A

Loop diuretics will reduce the fluid overload

ACE-inhibitors and beta blockers improve the long term prognosis

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12
Q

What commonly follows inferior MI?

A

Atrioventricular block

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13
Q

Most common cause of mitral stenosis?

A

Rheumatic fever

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14
Q

Most common cause of cardiac arrest post-MI? (3-5 days)

A

Ventricular fibrillation (extensive coagulative necrosis and neutrophils)

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15
Q

Event 0-24 hours post MI?

early necrosis

A

Ventricular arrhythmia
HF
Cardiogenic shock

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16
Q

Event 1-3 days post MI?

extensive necrosis + neutrophils

A

Ventricular fibrillation (cardiac arrest)

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17
Q

Event 3-14 days post MI?

macrophages + granulation at margins

A

Free wall rupture
Valve rupture
LV pseudoaneurysm

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18
Q

Event 2 weeks-several months post MI?

contracted scar

A

Dressler’s syndrome
HF
Arrhythmias
Mural thrombus

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19
Q

Causes of cardiogenic shock?

A

Infarcted ventricular wall (reduced stroke volume)

Free wall rupture

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20
Q

How do you improve prognosis of chronic heart failure?

A

Beta blockers

Loop diuretics

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21
Q

Inferior MI commonly can lead to…

A

AV block

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22
Q

Pericarditis chest pain differential?

Study These Flashcards
A

Worse when lying

23
Q

Dressler’s syndrome symptoms?

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A

Fever
High ESR
Pleuritic pain
Pericardial effusion

24
Q

What is associated with persistent ST elevation and LV failure?

Study These Flashcards
A

Left ventricular aneurysm

25
How do patients with LV free wall rupture present?
``` 1-2 weeks post-MI Acute HF secondary to cardiac tamponade Raised JVP Pulsus paradoxus Distant heart sounds ```
26
Treatment for LV free wall rupture?
Urgent pericardiocentesis and thoracotomy are needed
27
Presentation of ventricular septal defect:
First week post-MI Acute HF Pan-systolic murmur (Echo will differentiate between atrial mitre regurgitation which presents in a similar way)
28
Consequence of inferior-posterior infarction?
Acute mitral regurgitation
29
Cause of acute mitral regurgitation?
Ischaemia or rupture of the papillary muscle
30
Presentation of acute mitral regurgitation?
Acute hypotension Pulmonary oedema Early-to-mid systolic murmur
31
Treatment for acute mitral regurgitation?
Vasodilation and often surgical repair
32
Pericarditis postural effects?
Worse lying down | Relieved by leaning forward
33
Pericarditis pain profile?
Pleuritic | Worse when lying, better leaning forward
34
Global 'saddle shaped' ST elevation and PR depression indicated what?
Pericarditis (differential to MI as the ECG changes will be regional rather than global)
35
Features of acute pericarditis?
``` Pleuritic chest pain Non-productive cough, dyspnoea, flu-like symptoms Pericardial rub Tachypnoea Tachycardia ```
36
Management for pericarditis?
Immediately give all an echo Treat underlying cause Colchine and NSAIDs
37
Associated sign of Marfan's aortic dissection?
History of other connective tissue related problems like bilateral inguinal hernias
38
Classic history?
Vague constricting sensation at chest, neck, jaw, arms or shoulder lasting 15 mins Precipitated by exercise/emotional stress Relieved by rest/nitrates in less than 5 mins
39
1 symptom =
Non-anginal chest pain
40
2 symptoms =
Atypical angina
41
3 symptoms =
Typical angina
42
What do you give adenosine for?
Supraventricular tachycardia
43
Exacerbating factor?
Anything that raises basal metabolic rate e.g. exercise, cold, post-meal, psychological stress
44
Differentials:
COPD and asthma (both have similar SOB, chest pain, inability to expand chest) ACS = crescendo angina Oesophageal pain from hot/acidic drink
45
Cardiac work =
HR x BP
46
How to differentiate?
What relieves symptoms? | GTN and rest relieves angina, not rubbing, cold/warm fluids or antacids
47
Associated symptoms of angina:
``` Palpitations SOB Dizziness Dysphagia Fatigue ```
48
Past medical history?
AMI CABG/PCI CV Res Previous cardiac tests
49
Causes of myocardial ischaemia without coronary stenosis?
Aortic stenosis Left ventricular hypertrophy (increased after load) Microvascular dysfunction Severe anaemia
50
Tests in angina:
``` Troponin CTCA MRI Dobutamine stress ECHO Nuclear perfusion ```
51
ECG signs of PE?
S1Q3T3 Sinus tachycardia Signs of right heart strain T wave inversion in the anterior leads
52
What is the murmur in aortic regurgitation?
Early diastolic
53
Causes of aortic stenosis?
``` Degenerative calcification William's syndrome Bicuspid aortic valve Post-rheumatic disease Subvalvular: HOCM ```

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