Chest Pain Flashcards
(24 cards)
Causes of acute chest pain
Myocardial infarction Pulmonary embolism Pneumothorax Other causes of pleuritic pain Pericarditis Aortic dissection Ruptured oesophagus Oesophagitis Collapsed vertebrae Herpes zoster
Causes of chronic or recurrent chest pain
Angina Nerve root pain Muscular pain Oesophageal reflux Nonspecific pain
Main features of acute chest pain cause by myocardial infarction
Central
Radiates to neck, jaw, teeth, arms or back
Severe
Associated with nausea, vomiting and sweating
Main features of acute pain caused by a pulmonary embolism
Causes pain similar to MI if the embolus is central
Causes pleuritic pain if the embolus is peripheral
Associated with breathlessness or haemoptysis
Can cause haemodynamic collapse
Features of acute chest pain caused by lung disease (infection or pneumothorax)
Worse on breathing
Associated with cough
How to recognise pericardial pain?
Can mimic cardiac ischaemia and pleuritic pain
Relived by sitting up and leaning foreword
How to recognise an aortic dissection
Causes a ‘tearing’ pain (rather than crushing) and usually radiates to the back
How to determine if acute chest pain is oesophageal rupture
Follows vomiting
What is spinal pain affected by?
Posture
Associated nerve root pain follows nerve root distribution
What does examination finding of Lv failure suggest?
Myocardial infarction
What does a raised JVP suggest?
Myocardial infarction
Pulmonary embolus
What does a pleural friction rub suggest
Pulmonary embolism
Infection
What does a pericardial friction rub suggest?
Pericarditis (viral or secondary to MI)
Aortic dissection
What does aortic regurgitation suggest?
Aortic dissection
What does unequal pulses or unequal BP suggest?
Aortic dissection
What does bing tenderness suggest?
Musculoskeletal pain
What are the main signs to look out for in diagnosing angina?
Predictable
Usually occurs after a constant amount of exercise
Worse cod or windy weather
Induced by emotional stress
Induced by sexual intercourse
Relived by rest, and rapidly by a short acting nitrate (GTN spray)
What are the main physical signs of angina?
Evidence of risk factors - high BP, cholesterol, deposits, signs of smoking
Any signs of cardiac disease - aortic stenosis, an enlarged heart, signs of heart failure
Anaemia
Signs of peripheral vascular disease - suggesting coronary disease is also present
What is needed before diagnosing an MI
Abnormal ECG
An ECG will demonstrate ischaemia in patients with angina provided that the patient is having pain at the time of the ECG
What does the term acute coronary syndrome include? Elevation
MI with St segment elevation on ECG
Mi with only I ware inversion or St segment depression (shown by a troponin rise)
Chest pain with ischaemia ST segment depression but no troop in rise (unstable angina)
Sudden death due to coronary disease
What are the sequence of features characteristic of a ‘full-thickness’ or ST segment elevation MI?
Normal ECG ST segment elevation Development of Q waves ST segment returns to the baseline T Waves become inverted
Features of an ECG of a patient with an acute inferior infarction upon admission to hospital
Sinus rhythm
Normal axis
Small Q waves in leads II, III and VF
Raised ST segments in leads II, III and VF
Depressed ST segments in leads I, VL, V2, V3
Inverted T waves in leads I, VL, V3
Features of an ECG of a patient with an acute inferior infarction 3hours after admission
Sinus rhythm with ventricular extrasystoles
Normal axis
Deeper Q waves in leads II, III and VF
ST segments returning to normal, but still elevated in inferior leads
Less ST segment depression in leads I, VL, V3
Features of an ECG of a patient with an acute inferior infarction 2 days after admission to hospital
Sinus rhythm Normal axis Q waves in leads II, III, VF ST segments nearly back to normal T wave inversion in leads II, III, VF Lateral ischaemia has cleared (shown by ST segments in lateral leads)
