chest pain (W4)

Question 1

respiratory causes of chest pain?

Answer 1

pneumothorax
pneumonia
pulmonary embolus
pleurisy

Question 2

chest pain respiratory causes - features?

Answer 2

pleuritic
fever, productive cough
sudden onset
breathless

Question 3

gastrointestinal causes of chest pain

Answer 3

oesophageal reflux
peptic ulcer
pancreatitis
gallstones

Question 4

chest pain gi causes - features?

Answer 4

relationship to eating
epigastric pain
indigestion, heartburn
worse lying down

Question 5

MSK causes of chest pain?

Answer 5

muscle strain
rib fracture
costochondritis
myositis

Question 6

chest pain MSK causes - features?

Answer 6

provoking event
worse with movement
worse with breathing
tender points

Question 7

neurological causes of chest pain?

Answer 7

neuropathic pain
shingles
anxiety

Question 8

chest pain neurological causes - features

Answer 8

related psychiatric symptoms
follows dermatomal pattern
recurrent admissions, previous exclusion of underlying pathology

Question 9

cardiovascular causes of chest pain

Answer 9

ischaemic heart disease
pericarditis
aortic dissection
myocarditis (not going into detail so prob irrelevant)

Question 10

ischaemic heart disease - different clinical presentations?

Answer 10

stable angina
unstable angina
acute myocardial infarction

Question 11

what is angina?

Answer 11

mis-match between oxygen supply and delivery

Question 12

angina features

Answer 12

exertional pain/tightness/discomfort,
central chest, can radiate to throat/arm/back
relieved by rest, GTN sublingual spray
worse in cold/walking into wind

Question 13

how can GTN help diagnose angina

Answer 13

tell patient to use GTN for a week or two - if pain is relieved then could be angina

Question 14

investigations for angina

Answer 14

blood tests
12 lead ECG

Question 15

type of blood tests for angina and why?

Answer 15

full blood count - excludes anaemia
urea and electrolytes - normal renal
lipids - risk factor
glucose & haemoglobin A1c - diabetes

Question 16

first line diagnostic investigation for angina?

Answer 16

CT coronary angiography (not sure if this is right?)

Question 17

alternatives to CT coronary angiography

Answer 17

exercise tolerance test
pharmacological stress

Question 17

alternatives to CT coronary angiography

Answer 17

exercise tolerance test
pharmacological stress with imaging

Question 18

what drugs are given in a pharmacological stress with imaging test

Answer 18

adenosine/dobutamine - something that stimulates the heart

Question 19

pharmacological stress with imaging - types of scans

Answer 19

radionucleotide myocardial perfusion scan
echocardiography
cardiac MRI

Question 20

calcification?

Answer 20

hardening of the arteries, often occurs at the site of narrowing

Question 21

angina lifestyle management?

Answer 21

stop smoking
weight loss
exercise
diet

Question 22

angina management - drug therapy?

Answer 22

sup lingual GTN spray
aspirin
beta-blockers
calcium channel antagonists
atorvastatin
ACE inhibitor

Question 23

sub lingual GTN spray function? (angina)

Answer 23

symptomatic relief during anginal episode

Question 24

aspirin function? (angina)

Answer 24

antiplatelet

Question 25

beta-blockers function? (angina)

Answer 25

slows heart rate, reduced myocardial O2 demands

Question 26

calcium channel antagonists function? (angina)

Answer 26

coronary vasodilator

Question 27

atorvastatin function? (angina)

Answer 27

reduces cholesterol

Question 28

ACE inhibitor function? (angina)

Answer 28

treat blood pressure

Question 29

CVD risk factors

Answer 29

age, family history, blood pressure, cholesterol, diabetes, smoking, diet

Question 30

acute coronary syndrome (unstable angina) features - chest pain?

Answer 30

gradual or sudden onset crushing/weight/tightness radiate to neck/jaw/arms lasts over 15 mins

Question 31

acute coronary syndrome symptoms other than chest pain

Answer 31

nausea, vomiting, sweating, breathlessness

Question 32

what should be done within 10 minutes arrival of a patient presenting with unstable angina?

Answer 32

12 lead ECG

Question 33

investigation for unstable angina other than ECG? what does this indicate?

Answer 33

serum highly-sensitive troponin (indicates myocardial necrosis)

Question 34

12 lead ECG for unstable angina features?

Answer 34

ST segment changes: ST elevated MI (STEMI) non ST elevated MI (NSTEMI)

Question 35

what does each ECG letter represent

Answer 35

P - atrial contraction QRS - ventricular contraction T & U - repolarization

Question 36

what is ST elevation?

Answer 36

elevation of the segment on an ECG between S and T.

Question 37

what feature is present on an ECG weeks after a STEMI?

Answer 37

pathological Q wave (wider/deeper)

Question 38

what occurs in a NSTEMI?

Answer 38

ST wave becomes depressed, can develop into inversion

Question 39

what type makes up the majority of heart attacks?

Answer 39

NSTEMIs (80%)

Question 40

pathophysiological difference between NSTEMI and STEMI

Answer 40

STEMI - complete occlusion of coronary artery NSTEMI - threatened occlusion but not complete

Question 41

acute management of NSTEMI/STEMI

Answer 41

pain relief with morphine/opiate start oral aspirin and clopidogrel parental anticoagulation oral or iv betablocker

Question 42

parental anticoagulation?

Answer 42

heparin, LMWH, factor Xa inhibitor

Question 43

secondary prevention of future MI/strokes/death?

Answer 43

aspirin/clopidogrel beta-blocker ACE inhibitor/ARB (angiotensin receptor blocker) high dose atorvastatin treat diabetes if present lifestyle advice

Question 44

pericarditis presentation - ECG

Answer 44

can look like a heart attack. small amount of ST elevation PR depression

Question 45

aortic dissection - who does it occur in?

Answer 45

those with high blood pressure (mechanical tearing of lining) Marfan syndrome

Question 46

aortic dissection presentation?

Answer 46

severe, tearing, centre of chest through back between shoulder blades asymmetrical pulses

Question 47

diagnostic test for aortic dissection

Answer 47

CT scan chest with contrast (shows black line through aorta)