MedEd - Chest pain

Question 1

decubitus angina

Answer 1

symptoms occur when lying down

Question 2

prinzmetal angina

Answer 2

symptoms caused by coronary vasospasm

Question 3

coronary syndrome x

Answer 3

symptoms of angina but with normal exercise tolerance and normal coronary angiograms

Question 4

conservative stable angina treatment

Answer 4

stop smoking
lose weight
exercise

Question 5

medical treatment for angina

Answer 5

anti-anginals (BB/CCB)
symptomatic (GTN spray)
risk factor reduction (aspirin/statins/ACEi)

Question 6

ACS (3)

Answer 6

STEMI
NSTEMI
Unstable angina

Question 7

Differences between ACS types

Answer 7

STEMI/NSTEMI -
Unstable angina pectoris - chest pain at rest due to ischaemia without cardiac injury
BUT on presentation they all seem the same.

Question 8

Who may not get ACS symptoms?

Answer 8

Elderly
Diabetic
Women

Question 9

Investigations for ACS

Answer 9

ECG - STEMI - hyperacute T waves,, ST elevation, new-onset LBBB. UAP/NSTEMI - ST depression, T wave inversion

Question 10

Which artery supplied AV node

Answer 10

Right coronary artery - so you get complete heart block

Question 11

General ACS management

Answer 11

MONABAS(H)
morphine 
oxygen 
nitrates
antiplatelets (aspirin AND clopidogrel)
HOME:
beta-blockers 
ACE inhibitors 
statins

Question 12

aim of STEMI treatment

Answer 12

PCI
fibrinolysis
–> coronary reperfusion

Question 13

NSTEMI/UAP management

Answer 13

immediate -
aspirin
fondaparinux - because you are causing turbulent flow
UFH -

Question 14

Clopidogrel?

Answer 14

P2Y12 inhibitor of ADP receptor

Question 15

complications of ACS

Answer 15

DARTH VADER 
death 
arrhythmia 
rupture 
tamponate 
heart failure 
valve disease 
aneurists 
dressler's
embolism

Question 16

anticoagulants vs antiplatelets

Answer 16

venous (e.g.DVT, PE) - usually stasiss so activation of coagulation factors so ANTICOAGULANTS
arterial thrombosis (e.g. MI, stroke) - mostly caused by vessel wall injury so ANTIPLATELETS

Question 17

warfarin and ACS?

Answer 17

Do not use because it initally is PRO-THROMBOTIC

Question 18

pericarditis

Answer 18

inflammation of pericardium

Question 19

causes of pericarditis

Answer 19

idiopathic
Infective (e.g. Coxsackie B - common in young chest pain)
Connective tissue disease (e.g. sarcoidosis )
Dressler syndrome - (pericarditis that happens 2-10 weeks after MI)
Malignancy

Question 20

Dressler syndrome

Answer 20

pericarditis 2-10weeks after MI
antibodies against cardiomyocyte antigens against which they should not have been exposed to in the first place - AUTOIMMUNE

Question 21

symptoms

Answer 21

sharp, central chest pain 
pleuritis 
relieved by sitting forward 
fever/flu-like symptoms (if viral)
pericardial pleural rub

Question 22

pericarditis ECG

Answer 22

widespread saddle-shaped ST elevation, has a characteristic dip - NOT MI because the

Question 23

Beck’s triad

Answer 23

CARDIAC TAMPONADE triad:
muffled heart sounds
raised JVP
low BP

Question 24

AF causes

Answer 24

pneumonia 
PE
hyperthyroid
IHD
alcohol 
pericarditis

Question 25

AF symptoms

Answer 25

palpitations syncope symptoms of underlying causes irregularly irregular pulse

Question 26

AF ECG

Answer 26

absent P-waves | irregularly irregular

Question 27

DC cardioversion vs defibrillation

Answer 27

DC cardioversion - monitors electric conduction of heart and delivers shock at a specific time defibrillation - random shock that is hoped to re

Question 28

AF management

Answer 28

rhythm control - <48hrs since onset of AF: DC cardioversion, or chemical cardioversion (flecainide [contraindicated in IHD] or amiodarone). If >48hrs then anticoag for 3-4weeks beforecardioversion stroke risk stratification - CHADSVASC score used rate control - verapamil, digoxin, beta-blockers

Question 29

supraventricular cardioversion

Answer 29

regular, narrow complex tachycardia with no p waves and a supraventricular origin symptoms: palpitations, syncope, dyspnoea, chest discomfort

Question 30

types of SVT

Answer 30

AVRT | AVNRT

Question 31

Investigations for SVT

Answer 31

during tachy - regular,

Question 32

AVRT ECG

Answer 32

"delta wave" - slurred upstroke of QRS complex

Question 33

SVT treatment

Answer 33

1. Are they haemodynamically stable? NO - synchronised DC YES - step 2 2. Vagal maneouvres - e.g. Valsalva, cold water if they work stop, if not ... 3. .Adenosine 6mg - warn patients because it stops your heart for a while 4. Adenosine 12mg

Question 34

Who do you not use adenosine in ?

Answer 34

asthmatics | Use ramipril instead

Question 35

syncope definition

Answer 35

hypoperfusion to the brain causing LOC

Question 36

differential diagnosis of syncope

Answer 36

vasovagal - increased vagal discharge causing a drop in BP and HR. Can be percipitated by situations . May feel sweaty/pale before collapse arrhythmia - can lead to low-output state; palpitations before collapse outflow obstruction postural hypotension

Question 37

HOCM features (4)

Answer 37

jerky carotid pulse double apex beat ejection systolic murmur FH

Question 38

syncopal and non-syncopal causes of fainting

Answer 38

Syncopal - vertebrobasillar insufficiency, subclavian steal syndrome, aortic dissection Non-syncopal - intoxicatoin , head trauma, metabolic, epileptic seizures