M103 T3 L19 Flashcards by Joanna MacInnes

Which groups of structures in the chest can produce pain?

Cardiac 
Pericardial 
Oesophageal 
Pleural
Vascular
Musculoskeletal 
Neural

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What are examples of cardiac conditions that can cause chest pain?

muscle death / infarction, ischaemia, infection

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What are examples of Pericardial conditions that can cause chest pain?

inflammation, infection

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What are examples of Oesophageal conditions that can cause chest pain?

spasm, inflammation, rupture, varices

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What are examples of Pleural conditions that can cause chest pain?

infection, infarction, embolism, rupture / collapse

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What are examples of Vascular conditions that can cause chest pain?

rupture, inflammation [vasculitis], infection

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What are examples of Musculoskeletal conditions that can cause chest pain?

strain, spasm, tear, rupture, fracture

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What are examples of Neural conditions that can cause chest pain?

‘precordial catch, referred pain, neuropathy

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What are the two different types of structures that can cause chest pain?

superficial structures

deep structures

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What are examples of superficial structures that can cause chest pain?

skin
breast tissue
ribs

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What are examples of deep structures that can cause chest pain?

oesophagus
respiratory tract
lungs / pleura
heart
aorta
spine

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What areas is chest pain often referred to?

face
liver
arms
neck
(FLAN)
chest pain generally moves UP

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What are life threatening causes of chest pain?

Myocardial infarction / ischaemia
myocarditis / pericarditis
Pneumothorax
Massive pulmonary embolus & infarction
Ruptured aortic aneurysm
Ruptured oesophagus
Aortic dissection

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What is the spectrum for the severity of chest pain under ACS?

stable angina
unstable angina
NSTEMI

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What type of pain is described by patients with typical ACS chest pain?

central chest pain

usually accompanied by a squeezing or crushing sensation radiating up to the neck in the left arm

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What symptoms is ACS chest pain usually associated with?

Diaphoresis

grey colour or pallor

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Why are women more likely to experience a silent MI?

women often experience different classic symptoms to those of men - which are usually the only ones explained in the text books

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What symptoms are women much more likely to experience when having a heart attack?

shortness of breath, dizziness or nausea

abdominal pain, tachycardia

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What are words used to describe chest pain when taking histories?

Stabbing, knife-like, sharp
Gnawing, burning, numbing
Strangling, tightness, crushing, squeezing, constricting
Tearing, piercing

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What does SOCRATES stand for?

Site 
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbation
Severity

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When might chest pain radiate into the right arm of a patient having a myocardial infarction rather than into the left arm?

if it is a rare case of the patient having Dextracardia

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What are two terms associated with Acute Coronary Syndrome?

myocardial infarction

angina

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In what order does an examination into ACS occur?

Study These Flashcards

Inspection, Auscultation, Palpatation - IAP
BP, HR, RR
SaO2

What are the three types of investigations done in ACS?

Study These Flashcards

bloods
CXR
ECG

What is chest pain in ACS usually relieved by?

nitrates

If nitrates aren't working, why wouldn't you give the patient morphine?

opiates can drive oxidative stress which is harmful | instead, statins to help stabilise plaques

What are the markers for ACS in the blood?

troponins - troponin T C reactive protein or urea - indicates a lower respiratory tract infection D-dimer - pulmonary embolism

When are D-dimers helpful?

when the result is negative bc they have a low false negative rate has quite a high false positive rate bc it's not very specific to blood clots (e.g. poor renal function, infection, post surgery after many weeks)

What signs would you look for on a CXR of a MI patient?

``` consolidation changes in the cardiac shadow changes in the the aortic notch inflation of the lungs trauma ```

What features would you expect on a ECG from an MI patient?

ST elevation is classical, but NSTEMI is also completely normal

What is the purpose of performing serial ECGs on a patient?

looking for dynamic changes can indicate that there's some cardiac stress this is suggestive of ischaemia

What does the Oxford Handbook of Clinical Medicine state about all MI patients with a large PE?

that they will have the S1Q3T3 pattern, but that's actually rare clinically

What is a potential indicator of pericarditis?

periodic or sharp sounding central chest pain | dynamic change on the serial ECGs surrounding a saddle-shaped ST segment

How many squares would the PR segment be on an ECG normally?

about 3 squares

What is the PR interval on an ECG indicative of?

delay at the AV node

What might be the cause for changes to the PR interval over serial ECGs?

if damage is sustained to the AV node. if it is defective in way it works and if the patient has a condition like heart block (of first, second or third degree)

What are the effects of different degrees of heart block on the PR interval?

first - a delay | second & third - more complicated changes

What conditions might be associated with dyspensia?

gastritis esophagiti mucosal ulcers (might be the only symptom experienced)

What are some non-life threatening causes of chest pain in the heart?

heart burn GORD palpitations

What are some non-life threatening causes of chest pain in the musculoskeletal system?

Costochondritis Tietze's disease non-penetrating trauma

How are palpitations usually described by patients?

bubbles in the chest / like they've been thumped in the chest but they don't tend to be painful usually are quite self limiting, short lived and self resolving

What can the effects of non-penetrating trauma be if it is of sufficient force?

a pneumothorax

What combination of factors make it very likely that the patient is having a spontaneous pneumothorax?

young, slender, tall, male, active

What makes it more likely to be musculoskeletal in origin?

if the pain is reproducible on pressing or spraying of the chest

What makes it more likely to be musculoskeletal in origin?

if the pain is reproducible on pressing or spraying of the chest

What can pericarditis be caused by?

Can happen after an MI (Dressler’s) Viral infection in context of ‘flu like illness Coxsackie virus, mumps, herpes, HIV

How is osophageal pain usually described by patients?

burning, crushing, sharp, continuous, wave-like, or acute

When does osophageal pain usually get worse?

after eating on bending forward / lying flat raising head of bed smoking

What can cause oesophageal rupture?

mediastinitis | spontaneous (following violent vomiting)

How is pleuritic pain usually described by patients?

Severe ‘sharp’, ‘stabbing’ or ‘knife-like’ usually one sided worse on inspiration

What are the risk factors of pleuritic pain?

immobility, pregnancy, oestrogen therapy, obesity

What is the most common symptom of PE?

dysponea

What is shingles otherwise known as?

Herpes zoster

How does shingles usually present?

accompanied by a blistering rash with a dermatomal distribution – classically not passing the midline

What can nerve roots become compressed or irritated by?

vertebral body collapse (secondary to trauma or metastases) metastatic growth and invasion infection (including discitis)

M103 T3 L19 Flashcards

(55 cards)