Chest pain Flashcards
(137 cards)
1
Q
What can cause muscoskeletal chest pain
A
Sprained muscle from coughing
Bornholms disease
Idiopathic costochondritis
VZ infection
2
Q
What is bornholms disease
A
Cocksackie B infection leading to muscoskeletal pain
3
Q
What is Tietzes syndrome
A
Idiopathic costochondritis
4
Q
How does Varicella zosta infection lead to chest pain
A
Causes neuropathic pain restricted to a dermatome
5
Q
What gastro conditions can cause chest pain
A
Cholecystitis Peptic ulcer disease Pancreatitis Oesophagitis GORD Oesophageal spasm Boerhaves perforation
6
Q
Cardio conditions causing chest pain
A
ACS Pericarditis Aortic dissection Myocarditis Aortic stenosis
7
Q
What can cause a coronary vasospasm
A
Cocaine
8
Q
What can lead to an MI two pathophysiologies
A
Vasospasm
Blockage in vessel
9
Q
Examination findings MI
A
Xanthelasma Xanthomata- elbows back of hands Corneal arcus Cyanosis Weak pulses Bruits Legs look for ulcers hair loss Signs of arrythmia Signs of arrythmia or HB as can occur post MI
10
Q
How can brady or tachy arrythmias lead to MI
A
Reduced CO
11
Q
What can be lung finding of aortic dissection
A
Pleural effusion
12
Q
Risk factors for aortic dissection
A
HTN
Atherosclerosis
IHD history
Recent aortic valve replacement
13
Q
How is pneumothorax different from collapse
A
In collapse bronchus is blocked so air slowly gets absorbed into blood
14
Q
How can pneumothorax just present
A
SOB
15
Q
Do PE patients tend to show signs of hypoxia
A
Not normally only if massive
But can often show signs of desturation when walking
16
Q
How does a boerhaves perforation present
A
Chest pain
Haematemesis
SOB from pleurisy
17
Q
What is minimum amount of time takes for troponin to be elevated
A
3hrs
18
Q
How long can troponin be elevated for
A
Over 7 days
19
Q
What enzyme gets immediately elevated in MI
A
CK-MB
20
Q
How long does CK-MB stay elevated for
A
2-3 days
Note- if still elevated after this then recurrent infarcts
21
Q
Which patients are you wary of with elevated troponin
A
Renal patients as troponin should be excreted here
22
Q
What should do if patient with CKD presents with MI
A
Regulary repeat troponin and look at trend
23
Q
What can troponin also be elevated in
A
Note troponin equals cardiac damage Coronary artery spasm Aortic dissection-> iscahemia Myocarditis Cardiomyopathy Trauma HF
24
Q
What will happen to LDH and cholesterol post MI
A
Drops and levels wont return to normal for a long time so must be assessed straight away if want to act on it
25
U&Es relevance post MI
Can cause arrythmia- potassium main concern
26
What conditions causing chest pain will CRP and ESR be elevated in
Costochondritis
MI
Dissection
Myopericarditis
27
Why is glucose so important in chest pain
T2DM can present for first time with symptom of silent MIs
28
What are you looking for chest pain eCXR
```
Dissection- mediastinum widened
Boerhaaves- pneumomediastinum, effusion
Pneumothorax
Effusion
Pneumonia
```
29
Posterior MI on ECG
V1-V3 ST depression
30
How would aortic dissection appear on echo
False lumen
31
How to diagnose a boerhaves perforation
Chest radiograph with water soluble contrast agent like gastrograffin
32
If patient is vomiting in MI what drug must give
Metoclopramide
33
When do you only give oxyfen MI
O2 sats less than 94%
34
When are NSTEMI patients candidates for angioplasty
```
Haemodynamically unstable
LVD
Ventricular arrythmias
New mitral regurg or VSD
NOT candidates for thrombolysis
```
35
What score can be done to work out future care of NSTEMI patients
GRACE
36
Important secondary prevention post MI
```
Glucose control
BP control
Lifestyle changes
Aspirin for life and clopidogrel for 1 year
ACEi for life
Beta blockers for 1 year
```
37
If in HF post MI what should be given
Aldosterone antagonist- spironactalone
38
When can ICD be considered post MI
Sign of conduction block
| LVD
39
Complications of MI
```
Death
Arryhtmia
Rupture
Tamponade
HF
Valve disease
Aneurysm
Dressler syndrome
Embolism
Reinfarction
```
40
What is dressler syndrome
Autoimmune pericarditis 2-10 weeks post MI
41
What is most common post Mi pericarditis
In the few days following
42
Treatment of pericarditis
Analgesia
NSAIDS
PPI to account for great number of NSAIDS
Also monitor kidney function due to NSAIDS
43
Main complication of pericarditis
Pericardial effusion
44
How to treat pericardial effusion
Pericardiocentesis
45
What is important to ask about that relieves chest pain
GTN
| Antacids
46
Chest pain that isnt relieved by GTN
Must rule out oesophageal spasm
47
What is an oesophageal spasm
Strong spasms of oesophagus
48
How to diagnose oesophageal spasm
Barium swallow
Manometry
Trial of PPIs
49
If suffering angina symptoms but no angio/ECG symptoms what could be diagnosis
Prinzmetal angina
50
What is prinzmetal angina
Random coronary artery spasm
51
Other names for prinzmetal angina
Coronary syndrome X
| Variant angina
52
Cardiac tamponade on examination
Muffled heart sounds
| Distended neck veins
53
Main problem of arotic dissections
Tamponade
54
Difference between pericardial effusion and tamponade
Tamponades arise from effusion when ability of heart to contract is impaired by fluid
55
What could cause ST elevation with no angio signs
Artery spasm
56
What causes coronary artery spasm
Cocaine
57
Which MIs cause nausea and vomiting
Inferior as irritate diaphragm
58
What can cause pleural effusion with severe chest pain
Boerhaves syndrome
59
Complications of boerhaves syndrome
```
Pneumomediastinum
Pleural effusion
Mediastinitis
Sepsis
Death 30%
```
60
What is it called when inferior MI causes N&V
Bezold jarisch reflex
61
Other than ST depression in V1-V3 in posterior MI what else can be seen
Tall R waves
62
Why is troponin better than CK-MB
Specific to heart muscle
63
What artery is involved in posterior MIs
Circumflex
64
Which artery can be affected in lateral MI
LAD
| Circumflex
65
Initial investigations for angina
Exercise tolerance
Stress echocardiogram
Myoview scan
CT angio
66
What do you do if any of the initial tests for angina are positive
Angioplasty
67
Why would you do a stress echo
If patient has arthritis and cant do stress test
68
What is a stress echo
Patient given dobutamine to simulate stress
69
How will abnormal heart appear on stress echo
Normally a heart under stress will show increased motility but if not then will be hypokinetic
70
What is a myoview scan
Can be done on exercise bike or under induced stress with patients injected with thallium a radioactive agent and pictures with gamma camera are taken
71
What is normal on a myoview scan
Areas with good perfusion appear warm
72
What is a CTangio
CT synced up to heart beat and given contrast to view vessels. Calcium in calcified atherosclerotic plaques can be visualised and the degree of stenosis noted
73
ECG change seen minutes after occlusion
Hyperkalaemia- tented T waves
74
How long does T wave inversion last post MI
Develops 1-2 days after and persists for months after
75
If is ST depression or elevation in all chest leads what is affected artery
LCA
76
What leads are affected in left circumflex problems
I
aVL
V5
V6
77
Drugs used in stable angina
```
ACEi
Statins
Aspirin
GTN spray
Anti anginals
```
78
What are some anti-anginals
Beta blockers
| CCBs
79
Define unstable angina
Chest pain at rest due to ischaemia but wihtout cardiac injury
80
What are precordial chest leads
Those on the chest
81
ECG changes seen in STEMI
Hyperacute T waves
ST elevation
New LBBB
82
Management of STEMI
Work out less than when symptoms started
If less than 12 hours do PCI if can do PCI within 120mins
If less than 12 hours and cant do PCI in 120mins do thrombolysis
If over 12 hours do angio then PCI if possible
83
Management of NSTEMI immediately
```
MONA
But also give LMWH
Then use GRACE score to assess risk
If Low outpatient angio
If high inpatient angio with possible PCI and can give DOAC
```
84
What is fondaparinux or enoxaparin
LMWH
85
Causes of pericarditis
```
Viral- cocksackie A9, EBV, mumps
Bacterial
CTD- sarcoidosis
AIs
Dressler syndrome
```
86
Rfs pericarditis
```
Male
20-50
Previous MI
Cardiac surgery
Cancer
Uraemia
```
87
Where can pericarditis pain radiate
Trapezius sx
88
How else can pericarditis present
Tamponade
89
What is becks triad
Seen in cardiac tamponade
90
Becks triad
Distended neck veins
Low BP
Muffled heart sounds
91
How to manage pericarditis with tamponade
Pericardiocentesis
92
How to manage pericarditis
NSAID and PPI(ulcer prevention)
| Colchicine
93
What drug can prevent chronic pericarditis
Colchicine
94
Complications of pericarditis
Chronic constrictive pericarditis
| Tamponade and effusion
95
What is carotid sinus syndrome
Vasovagal syncope
96
Cardiac red flags in syncope
LOC during exercise
Severe valvular disease
Previous arrythmia
Concerning ECG
97
Signs on vasovagal syncope in history
Nausea
Pallor
Loss of hearing/vision
Light headed
98
How to manage vasovagal syncope
Educate on triggers
| Physical counter pressure movements
99
What are physical counter pressure movements for vasovagal
Squatting
Isometric forearm grip
Leg crossing with buttocks and thighs tense
100
Complications of AF
Thromboembolism
| Worsened HF
101
What must you do before AF cardioversion
Do TEE to see if IHD
102
What are options for rate control in AF
Bisoprolol
Verapamil
Digoxin
Diltiazem
103
What causes atrial flutter
Underlying heart disease
104
What causes HBs
```
IHD
Rheumatic fever
Drugs- CCB, b blockers and amiodarone
Metabolic- hyperkalaemia, hypothyroid
Sarcoid
```
105
Symptoms of 1st HB
Asymptomatic
106
Symptoms of T1 2 HB
Asymptomatic
107
Symptoms of T2 2 HB
```
Dizzy
Syncope
Dizzy
Chest pain
HF
```
108
Symptoms of T3 HB
```
Dizzy
Syncope
Dizzy
Chest pain
HF
```
109
What is T1 2 HB also called
Mobitz
110
What is T2 2 HB also called
Wenkerback
111
Investigations for HB
```
ECG
Troponin
K+, Ca2+
Digoxin toxicity
Echo
```
112
Management for 3rd HB
Permenant pacemaker
113
Management for acute HB secondary to MI
IV atropine
| External pacing
114
Complications for HB
Asystole
HF
Cardiac arrest
115
Long term management of SVT
Ablation
116
Management of VT haem stable
Amiodarone 300mg IV
117
Management of VT haem unstable
If pulse DC cardiovert
118
Causes of VT
Long QT
Electrolyte imbalances
Illicit drugs
119
Main symptom of VF
Unconscious
120
Causes of VF
```
MI
Phaeos
Electrolye imbalances
Hypoxia
Acid base imbalances
Hyper or hypothermia
LongQT or brugada
```
121
Rfs for WPW
```
Ebsteins anomaly
Heart defect
Mitral valve prolapse
Marfans
Aortic coarctation
```
122
Symptoms of WPW
Palpitations
| Chest pain
123
Management of unstable WPW
DC cardiovert
124
Management of stable WPW
SVT management
125
Long term management of WPW
Ablation to remove accessory
| Anti-arrythmic
126
Complications of WPW
Sudden cardiac death
| Ablation SE
127
Ablation SEs
Bleeding
Infection
Pneumothorax
128
What is oesophagitis secondary to
GORD
| Hiatus hernia
129
Chest pain radiating to back ddx
Dissection
Pancreatitis
Pericarditis
130
What can be immediate sign of MI on ECG
Hyperacute T waves
131
How much ST elevation must there be for a man over 40
Over 2mm
132
How much ST elevation must there be for a man under 40
Over 2.5mm
133
How much ST elevation must there be for a woman
Over 1mm
| Over 1.5mm in V2/3
134
What must be there to confirm a STEMI
ST elevation in at least 2 leads
| Meets mm guidelines
135
Bloods ordered in MI
```
FBC
U&Es
CRP
Glucose
Lipids
Troponin
CK-MB
BNP
TFTs
Amylase
```
136
Other than ST elevation what may be seen on ECG
New onsent LBBB
137
What is lassitude
State of general unwell and tired
