Cardiology: Unstable Angina and Myocardial Infarction

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Questions and Answers

What is a characteristic of chest pain in unstable angina?

Only relieved by rest

Abrupt onset (correct)

Only occurs with exertion

Gradual onset

What is a symptom associated with myocardial infarction?

Itching

Pallor

Restlessness (correct)

Numbness

What is a characteristic of pericardial pain?

Constant anterior central chest pain (correct)

Relieved by movement

Radiates to the back

Radiates to the arms

What is a characteristic of aortic dissection?

Abrupt onset of severe, tearing chest pain Signup and view all the answers

What is the most common cardiovascular cause of dyspnea?

Heart failure Signup and view all the answers

What is a common feature of angina pectoris?

Relieved by rest Signup and view all the answers

What is a characteristic of autonomic stimulation?

Sweating, pallor, nausea, and vomiting Signup and view all the answers

What is a risk factor for unstable angina?

Diabetes Signup and view all the answers

What should you ask about in patients who present with syncope?

The circumstances of the event and any preceding symptoms Signup and view all the answers

What is oedema?

Excess fluid in the interstitial space Signup and view all the answers

What is a common cause of bilateral lower limb oedema?

Heart failure Signup and view all the answers

What is a cause of unilateral oedema?

Deep vein thrombosis Signup and view all the answers

What is a cause of non-pitting oedema?

Lymphoedema Signup and view all the answers

What should you ask about in a patient's past medical history?

Conditions associated with increased risk of vascular disease Signup and view all the answers

Why should you enquire about other symptoms of fluid overload?

To look for symptoms of fluid overload, including dyspnoea, orthopnoea, and abdominal distension Signup and view all the answers

What is a side effect of vasodilating calcium channel antagonists?

Oedema Signup and view all the answers

What is an occupation that may be affected by limiting exertional symptoms?

Construction worker Signup and view all the answers

What is a factor that can cause arrhythmias?

Recreational drugs Signup and view all the answers

What is the first step in the CVS examination sequence?

General Examination Signup and view all the answers

What should you examine in the face to look for signs of cardiovascular disease?

The mouth for Cyanosis Signup and view all the answers

What is an observation that can be made during the eye examination?

Corneal arcus Signup and view all the answers

What is an observation that can be made during the hands examination?

Tobacco stain on the fingers Signup and view all the answers

What is the purpose of measuring capillary refill time during the hands examination?

To evaluate blood circulation Signup and view all the answers

What is an observation that can be made during the general examination?

Pallor Signup and view all the answers

What is the term for dyspnoea caused by myocardial ischaemia?

Angina equivalent Signup and view all the answers

What is the term for dyspnoea on lying flat?

Orthopnoea Signup and view all the answers

What can cause sudden breathlessness that wakes the patient from sleep?

Paroxysmal nocturnal dyspnoea Signup and view all the answers

What is palpitation?

An unexpected or unpleasant awareness of the heart beating in the chest Signup and view all the answers

What is the purpose of detailed history taking in palpitation?

To distinguish the different types of palpitation Signup and view all the answers

What is syncope?

A transient loss of consciousness due to transient cerebral hypoperfusion Signup and view all the answers

What is presyncope?

A sensation of lightheadedness and impending loss of consciousness Signup and view all the answers

What is a common cause of syncope?

Postural hypotension Signup and view all the answers

What is a potential cause of bacteraemia in patients with suspected infective endocarditis?

Recent dental work Signup and view all the answers

Which of the following systemic disorders is associated with aortic dissection?

Marfan's syndrome Signup and view all the answers

What is a common side effect of non-steroidal anti-inflammatory drugs (NSAIDs) that patients should be aware of?

Cardiovascular manifestations Signup and view all the answers

What is the significance of asking about premature coronary artery disease in first-degree relatives?

To identify a risk factor for cardiovascular disease Signup and view all the answers

What is the association between familial hypercholesterolaemia and cardiovascular disease?

It is associated with premature arterial disease Signup and view all the answers

What is the strongest risk factor for coronary and peripheral arterial disease?

Smoking Signup and view all the answers

What is the association between obesity and cardiovascular disease?

It is associated with hypertension and dilated cardiomyopathy Signup and view all the answers

What is the significance of asking about a family history of sudden unexplained death at a young age?

It is associated with a risk of cardiomyopathy or inherited arrhythmia Signup and view all the answers

Study Notes

Acute Chest Pain

Abrupt onset or worsening of chest pain episodes that may occur on minimal exertion or at rest with no definable exacerbating or relieving factors
Associated features include restlessness, breathlessness, and a feeling of impending death (angor animi)
Autonomic stimulation may result in sweating, pallor, nausea, and vomiting

Myocardial Infarction

Causes symptoms that are similar to, but more severe and prolonged than, those of angina pectoris
Associated features include restlessness, breathlessness, and a feeling of impending death (angor animi)

Pericardial Pain

Typically a constant anterior central chest pain that may radiate to the shoulders

Aortic Dissection

Abrupt onset of very severe, tearing chest pain that radiates to the back (typically the interscapular region)
May be associated with profound autonomic stimulation and radiolradial delay

Dyspnea (Breathlessness)

Cardiovascular causes of dyspnea include:
- Heart failure (most common cardiovascular cause of both acute and chronic dyspnea)
- Pulmonary embolism
- Arrhythmia
Dyspnea caused by myocardial ischaemia is known as 'angina equivalent'

Orthopnoea

Dyspnea on lying flat, may occur in patients with heart failure
Lying flat increases venous return and in patients with left ventricular impairment may precipitate pulmonary oedema
Severity can be graded by the number of pillows used at night ('three-pillow orthopnoea')

Paroxysmal Nocturnal Dyspnoea

Sudden breathlessness that wakes the patient from sleep, caused by the same mechanism as orthopnoea

Palpitation

Unexpected or unpleasant awareness of the heart beating in the chest
Detailed history taking can help to distinguish the different types of palpitation

Syncope and Presyncope

Syncope is a transient loss of consciousness due to transient cerebral hypoperfusion
Causes include postural hypotension, dehydration, neurocardiogenic syncope, arrhythmias, and mechanical obstruction to cardiac output
Presyncope is a sensation of lightheadedness and impending loss of consciousness without progressing to actual loss of consciousness

Oedema

Excess fluid in the interstitial space causes oedema (tissue swelling)
Causes include:
- Heart failure (common cause of bilateral lower limb oedema)
- Deep vein thrombosis (unilateral, non-pitting oedema)
- Chronic venous disease
- Vasodilating calcium channel antagonists
- Hypoalbuminaemia

Cardiovascular Examination

CVS examination sequence:
1. General examination (vital signs, appearance, awareness, body built, color)
2. Examination of the neck veins
3. Examination of the precordium (chest region, heart)
4. Examination of peripheral vascular system

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Description

This quiz covers the differences between unstable angina and myocardial infarction, including symptoms, triggers, and severity of chest pain episodes.