Session 8 Flashcards
(111 cards)
1
Q
Name two respiratory causes of chest pain
A
Pneumonia
Pulmonary embolism
2
Q
Describe how a patient with chest pain as a result of pneumonia will present
A
With VAGUE chest pain described
In lung that the infection is in
3
Q
Describe how a patient with chest pain as a result of pulmonary embolism will present
A
Sharp pain
Well localised
Worse when breathing in/coughing
4
Q
What makes the chest pain seen in pulmonary embolism worse?
A
Breathing in/coughing
5
Q
What happens in pulmonary embolism?
A
There is blockage in a vessel of the pulmonary circulation by an emboli
6
Q
Describe two cardiac causes of chest pain
A
Ischaemic
Pericarditis
7
Q
Describe how a patient with ischaemic chest pain will present
A
Dull pain at the centre of the chest
May radiate
8
Q
What is the term given to the a pain in the CENTRE of the chest?
A
Retrosternal
9
Q
Where might the chest pain as a result of ischaemia radiate?
A
Jaw
Neck
Shoulders
10
Q
Describe how localised the pain is in chest pain caused by PE compared to chest pain caused by ischaemia
A
Chest pain as a result of ischaemia less localised than in PE
11
Q
Name an aggravating factor in chest pain due to ischaemia
A
Exertion
12
Q
What is pericarditis?
A
Inflammation of the pericardial sac
13
Q
Describe how a patient with chest pain due to pericarditis will present
A
Sharp pain
Centre of chest (retrosternal)
14
Q
What are some relieving factors in chest pain as a result of pericarditis?
Aggravating factors?
A
Sitting up
Leaning forward
Lying flat
Deep breaths
Coughing
15
Q
What sound might be heard as a result of (chest pain due to) pericarditis?
A
Pericardial rub (coarse heartbeat)
16
Q
What is pericardial rub?
A
The coarse heartbeat sound heard in individuals with pericarditis
17
Q
How can pericarditis affect an ECG?
A
ST segment elevation
18
Q
What is an upper GI cause of chest pain?
A
Reflux
19
Q
What happens in reflux?
A
Acidic contents of the stomach goes up into the oesophagus
20
Q
Describe how a patient with chest pain as a result of reflux will present
A
Burning pain
Centrally/Running up the chest
21
Q
What are some aggravating factors of chest pain due to reflux?
A
Lying flat
Worse after food
22
Q
Describe two musculoskeletal causes of chest pain
A
Rib fracture
Costochondritis
23
Q
Describe how a patient with chest pain as a result of a rib fracture will present
A
Sharp pain
Localised
Tender to palpate
24
Q
What are some aggravating factors of chest pain due to rib fracture?
A
Movement of chest wall - e.g. Inspiration/Coughing
25
What is costochondritis?
Inflammation of the costal cartilages of the ribs
26
Describe how a patient with chest pain as a result of costochondritis will present
Sharp pain
Localised
Tender to palpate
27
What are some aggravating factors of chest pain due to costochondritis?
Worse with chest wall movement - inspiration/coughing
28
Describe pleural/pericardial pain with cardiac ischaemic chest pain
Cardiac ischaemic chest pain
- visceral pain
- dull, poorly localised
- worse with exertion
Pleural/pericardial pain
- somatic pain
- sharp, well localised
- worse with inspiration/coughing
29
Describe the aggravating factors of cardiac ischaemic chest pain compared to pleural/pericardial chest pain
Pleural pericardial - inspiration/coughing/movement
Cardiac ischaemic - exertion
30
Name a cardiac...
I) ischaemic
II) non-ischaemic
...cause of chest pain
Ischaemia, Infarction
Pericarditis
31
Name 6 non-cardiac causes of chest pain
Pneumonia
Pulmonary embolism
Reflux
Costochondritis
Rib fracture
Aortic dissection
32
What is atherosclerosis? What effect does it have on arteries?
Build up of fat in arteries
Narrows them, plaque/atheroma production
33
Describe the structure of the plaques seen in atherosclerosis
Lipid-laden core with a fibrous cap
34
What is ischaemic heart disease?
Disease of the coronary arteries
35
The risk factors for atherosclerosis are the same as the risk factors for...
IHD
Ischaemic Heart Disease
36
State 6 modifiable risk factors for atherosclerosis and ischaemic heart disease
```
Smoking
Hypertension
Hypercholesterolaemia
Diabetes
Obesity
Sedentary lifestyle
```
37
State 3 non-modifiable risk factors for atherosclerosis and ischaemic heart disease
Age (older)
Gender (male)
Family history
38
Angina is caused by the ____________ of coronary arteries
This is usually as a result of...
Occlusion
Atherosclerosis
39
Describe the atherosclerotic plaque seen in stable angina
It is stable
40
When does heart tissue ischaemia occur?
When the metabolic demands of cardiac muscle are greater than what can be delivered by the coronary arteries
41
Describe how a patient with stable angina will typically present
Dull retrosternal pain
42
The pain experienced in stable angina is triggered by...
Exertion
43
Why does exertion trigger the pain seen in stable angina?
Blood flow through the narrowed coronary arteries is not adequate for the increased demands of cardiac muscle
44
What is the chest pain seen in stable angina relieved by?
Rest
45
In someone with stable angina, is the chest pain seen during rest?
No
46
What drug can be given to someone experiencing chest pain as a result of stable angina?
GTN spray
47
What is acute coronary syndrome?
Acute myocardial ischaemia caused by atherosclerotic coronary artery disease
48
Acute coronary syndromes include which 4 conditions?
Unstable angina
MI
NSTEMI
STEMI
49
When can an atherosclerotic plaque cause acute coronary syndrome/ischaemia?
Atherosclerotic plaque ruptures and a thrombus forms causing an acute increased occlusion of the coronary artery
50
What happens once an atherosclerotic plaque ruptures in a coronary artery?
Platelet aggregation and formation of a thrombus resulting in partially-completely occluded coronary artery
51
Compare the size of the coronary artery lumen seen in...
Unstable Angina
NSETMI
STEMI
Unstable Angina - partially occluded lumen
NSTEMI - more occluded
STEMI - completely occluded
52
Do cardiac enzymes leak out of ISCHAEMIC cardiac cells?
No
53
Do cardiac enzymes leak out of infarcted (necrosed) cardiac cells?
Yes
54
Unstable angina has many similarities to stable angina. What is the main different symptom between the two?
Name 3 other potential differences
Unstable Angina - chest pain occurs at rest
Pain more intense
Pain lasts longer
GTN spray no longer works
55
Does GTN spray work to relieve chest pain in unstable angina?
No
56
Unstable angina has a risk of deteriorating further to...
NSTEMI
| STEMI
57
Describe the pain experienced by someone with MI
Dull, retrosternal/central pain
Chest pain is experienced at rest
Pain may radiate to neck/shoulders
58
Do patients with MI experience their chest pain at rest?
Yes
59
Where may the pain experienced by a patient with MI radiate to?
Neck
| Shoulders
60
Is the chest pain experienced in MI usually dull or sharp?
Where is the pain usually located?
Dull
Centrally (retrosternal)
61
Describe the typical general appearance of someone with MI
Looks unwell
Sweaty
Pallor
Nauseous
62
Sweaty, pallor and nauseous may all be features of a patient presenting with MI, what do these features indicate?
Increased autonomic output
63
The pain with MI usually lasts longer than ____ minutes with _______________ onset
15
Spontaneous
64
MI can be 'painless' in which individuals?
Diabetics
65
What are two diagnostic tests used for suspected acute coronary syndrome?
ECG
| Blood Tests
66
What sections of the ECG would you look at/for when investigating suspected acute coronary syndrome?
ST Segments
T Waves
Pathological Q Waves
67
What would be specifically looked for in blood tests for suspected acute coronary syndrome?
Troponin levels
68
Troponin in the blood indicates...
Cardiac myocyte death
69
What acute ECG changes are seen in STEMI?
ST segment elevation
| Hyper-acute T waves
70
Describe the appearance of hyper-acute T waves
Big + Pointy
71
ST elevation will be seen on which leads of an ECG in a STEMI?
Leads facing the damaged part of the heart
72
Describe the evolution of a STEMI on an ECG in the following different stages...
I) minutes-hours
II) hours-day
III) week
IV) months
ST elevation
Hyperacute T waves
ST elevation
T inversion
Pathological Q waves (deeper)
Reduction in ST elevation
T inversion (smaller)
Pathological Q wave (deeper)
Pathological Q wave persists
73
What ECG changes are seen as a result of a STEMI in the first few minutes/hours?
ST elevation
| Hyper-acute T waves
74
What ECG changes are seen in a STEMI after a few hours- a day?
ST elevation
T inversion
Pathological Q waves
75
What ECG changes are seen in a STEM after a week?
Less ST elevation
Pathological Q waves
Less deep T inversion
76
What ECG change may be seen in a STEMI after months?
Pathological Q waves
77
Describe the ECG changes seen in unstable angina/NSETMI
ST Depression
| T Wave Flattening/Inversion
78
Both unstable angina and NSTEMI show similar ECG features (ST segment depression/T inversion or flattening). How are the two distinguished?
By checking troponin levels
79
Ischaemic heart disease relates to disease affecting the ____________ _________ usually _________________
Coronary arteries
Atherosclerosis
80
Acute coronary syndromes include which 3 conditions? What development of atherosclerosis usually causes acute coronary syndromes?
Unstable Angina
NSTEMI
STEMI
Acute plaque rupture
81
What is the most usual cause of stable angina? How does this result in stable angina?
Coronary artery stenosis
Reduced perfusion of myocardium
82
Other than coronary artery stenosis name two other potential causes of stable angina
Anaemia
Severe aortic valve stenosis
Hyperthyroidism
83
Why can severe aortic valve stenosis result in stable angina?
Not enough blood travels through coronary arteries from LV
84
Name three investigations that may be carried out in stable angina
Bloods
ECG
Chest X-ray
85
What may be looked at in the blood during investigations for stable angina?
FBC (anaemia?)
Cholesterol
Troponin (not present in stable angina)
86
Why might a resting ECG be used in investigations for stable angina?
May give indications of previous MI (e.g. Q waves), rhythm disturbances, AF
87
What tests can be used to test for ischaemia and its extent (4)
Treadmill test
Dobutamine stress echo
Treadmill stress echo
Myocardial perfusion stress test
88
What happens in treadmill tests?
ECG/BP is measure whilst exercise is carried out
89
What happens in a dobutamine stress echo?
Medication is used to stress the heart and echocardiogram carried out
90
What happens in a treadmill stress test?
Exercise is used to stress the heart and echocardiogram is carried out
91
What happens in myocardial perfusion stress test?
Maximum vasodilation achieved with drugs and if there is a stenosis in an artery, a patch will show up on imaging
92
Name 7 potential treatments for stable angina
```
Aspirin
Beta blocker
Statin
ACE inhibitor
Oral nitrate
Nicorandil
CCB (Ca Channel Blockers)
```
93
How does aspirin work in the treatment of stable angina?
Acts as an anti-platelet drug preventing platelets sticking together
94
What two effects do beta blockers have?
Slows the heart rate
| Drops the blood pressure
95
How do statins work in the treatment of stable angina?
Reduce LDL cholesterol build-up
96
How does oral nitrate work compared to GTN spray in the treatment of stable angina?
Longer lasting
| Oral
97
What effect do calcium channel blockers have on an individual's blood pressure?
Anti-hypertensive (reduced bp)
98
Name two different revascularisation treatments used when there is plaque blockage of coronary arteries
Percutaneous coronary intervention (PCI)
| Coronary artery bypass grafting (CABG)
99
What happens in PCI (percutaneous coronary intervention)and how is it carried out?
A non-surgical procedure where a catheter is used to place a stent in atherosclerotic coronary arteries to open them up
100
What happens in CABG (coronary artery bypass grafting)?
Other vessels are grafted around the coronary artery with plaque blockage to supply more blood to the area by bypassing the narrowing
101
Give two examples of vessels that may be grafted during CABG?
Saphenous vein
| Internal mammary artery
102
What is the usual cause of unstable angina?
Coronary plaque rupture
103
Name 4 typical investigations that could be carried out in suspected acute coronary syndrome
Bloods
ECG
Troponin
Chest X-Ray
104
Describe the occlusion of a coronary artery seen in STEMI
Acute total occlusion of a major coronary artery seen
105
Describe the occlusion of a coronary artery seen in NSTEMI
Acutely progressive tight stenosis of a coronary artery
106
Name 4 cardiac conditions where you may see troponin released
```
ACS
Myocarditis
Cardiac Amyloidosis
Aortic Dissection
Acute Heart Failure
Prolonged Tachycardia
```
107
Name 3 non-cardiac conditions where you may see troponin released
```
Acute PE
Pulmonary hypertension
Sepsis
Severe anaemia
Kidney failure
Cardiac amyloidosis
```
108
What is a problem with using troponin as a marker for myocardial damaged?
It has poor specificity and is released in almost any condition
109
The treatments of unstable angina/MI are aimed at...
Treating the symptoms/prognosis
110
How would unstable angina be treated?
By optimising general condition
Drugs (Pharmacological)
Reperfusion - e.g. CABG/PCI
111
How would myocardial infarction be treated?
```
Oxygen
Pain relief
GTN sublingually
Aspirin (anti-platelets)
Reperfusion - e.g. CABG/PCI
```
