A 64-year-old self-employed man presents at your surgery complaining of increasing breathlessness, with chest pain on exertion. He says he smokes about 20 cigarettes per day and drinks moderately. His father died of a heart attack at the age of 50. His mother is still alive at the age of 95. 12 months ago, he noticed breathlessness when playing tennis. Since that he has become more breathless during exercise. Over the past few weeks he is out of breath when walking more than about 20 m without rest and has pain in his chest if he tries to hurry. On examination his HR was 98 b/min, BP 160/110 mmHg and ECG shows no significant changes Show differential diagnosis? pulmonary, cardiovascular, GI, musculoskeletal - stable angina should be suspected on the basis of the clinical assessment and the typicality of chest pain How does typical angina present? with all 3: - precipitated by physical exertion - constriction discomfort in the front of the chest, in the neck, shoulders, jaw, or arms - relieved by rest or glyceryl trinitrate (GTN) within about 5 minutes How does atypical angina present? with 2 of the below features: - precipitated by physical exertion - constriction discomfort in the front of the chest, in the neck, shoulders, jaw, or arms - relieved by rest or glyceryl trinitrate (GTN) within about 5 minutes in addition: include GI discomfort and/or breathlessness and/or nausea What factors make a diagnosis of stable angina less likely? - pain that is continuous or prolonged - pain that is unrelated to actvity - pain brought on by breathing - pain associated with dizziness, palpitations, tingling, or difficulty swallowing What is the classification of angina? stable angina: pain or discomfort that occurs when the heart must work harder, usually lasts a short time (less than 5 min) - relieved by rest or medicine unstable angina: often occurs when resting, lasts longer than stable angina; rest or medicine do not help relieve it; gets worse over time prinzmetal: pain from variant angina caused by a spasm in coronary arteries caused by exposure to cold, stress, smoking Tests to do for stable angina? - ECG Important. cardiac enzymes? - troponin When will blood levels of troponin be elevated? within a few hours of heart damage and remain elevated for up to 2 weeks -> if levels normal, much less likely that the symptoms and chest pain are due to heart muscle damage and more likely pain is due to stable angina Managing patients with stable angina? ST elevation in leads I, avL, and V6 lateral STEMI - reciprocal changes ST depression in inferior leads (III and avF) What are the different types of MI based upon the areas of infarct and how will you diagnose them by looking at the ECG? First line management for STEMI?
1. antiplatelet and add-on antiischaemic/anticoagulant treatment 2. reperfusion therapy 3. long term managemet: ACE inhibitor, b-blocker, statin, anti-platelet therapy, cardiac rehabilitation, lifestyle changes lead II and III ST depression and T wave inversions? NSTEMI/ unstable angina Pathologically, what is the difference between STEMI, NSTEMI, and unstable angina? STEMI - nearly always coronary plaque rupture resulting in thrombosis formation occluding a coronary artery NSTEMI - incomplete thrombus formation -> troponin elevation! unstable angina: plaque becomes unstable, fibrous cap disrupts, and thrombus is formed but still enough lumen to meet demand during rest Difference between NSTEMI and unstable angina clinically? NSTEMI - elevated troponin unstable angina - normal troponin -> both have no ST elevation Treating NSTEMI and unstable angina? What is the difference between angina and myocardial infarction?The key difference between angina and a heart attack is that angina is the result of narrowed (rather than blocked) coronary arteries. This is why, unlike a heart attack, angina does not cause permanent heart damage.
What is difference between pain in angina pectoris and pain in myocardial infarction?Angina is the specific type of pain you experience when the heart is in trouble. Heart attacks, on the other hand, occur when the narrowing is severe or causes a blockage, leading to actual damage to the heart muscle. In other words, a heart attack is an actual medical condition and angina is a symptom.
What test distinguishes myocardial infarction from unstable angina?Currently, cardiac troponins are the gold standard of biomarkers for establishing a diagnosis of AMI. Any elevation in the circulating levels of these biomarkers also may provide a clinical distinction between UA and NSTEMI.
What is difference between myocardial infarction and myocardial ischemia?Myocardial ischemia occurs when blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (atherosclerosis). If the plaques rupture, you can have a heart attack (myocardial infarction).
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Difference between angina and myocardial infarction quizlet
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