Signs, Symptoms & RFs

• What are the symptoms of classical angina?

  ‘Heavy’, ‘tight’ or ‘gripping’ central or retrosternal pain (may radiate to jaw and/or arms)

  Pain occurs with exercise or emotional stress

  Pain eases rapidly with rest or with GTN
• What are the differential diagnosis of central chest pain?

  Depends on the pain

  • Retrosternal heavy or gripping sensation with radiation to left arm or neck, provoked by exertion & eased with rest or nitrates → angina
  • Similar pain @ rest → acute coronary syndrome
  • Severe, tearing chest pain, radiating to back → aortic dissection
  • Sharp, central chest pain worse with movement or respiration & relieved with sitting forward → pericarditis
  • Sharp, stabbing, left submammary pain (associated with anxiety) → da Costa’s syndrome

  Non-cardiac

  • PE
  • Oesophageal disease
  • Mediastinitis
  • Costochondritis
  • Trauma
• What are the differential diagnosis of lateral/peripheral chest pain?

  Pulmonary

  • Infarction
  • Pneumonia
  • Pneumothorax
  • Lung cancer
  • Mesothelioma

  Non-pulmonary

  • Bornholm disease
  • Herpes zoster
  • Trauma
• What are the atypical signs & symptoms of MI?

  Absent chest pain

  Pain in jaw, neck, arms, back, abdomen

  Weakness

  Cough

  Dyspnoea

  May have indigestion, heartburn
• Why is pain from MI referred to the left arm?

  Pain can be felt in your left arm as the pain signalling neurons for heart and left arm go to the same brain cells and therefore the brain can't isolate the pain given by cardiac myocyte. This is called 'refered pain'.
• What are the typical signs & symptoms of MI?

  Chest pain

  Pain commonly radiates to left chest, arm, shoulder, neck, jaw

  Dyspnoea

  Pallor

  Diaphoresis

  Tachycardia

  Dizziness

  Nausea & vomiting
• What is priapism?

  Erection lasting more than 4 hours = medical emergency
• Who is more likely to show atypical signs of MI?

  Women

  Diabetics
• What is intermittent claudication?

  Muscle pain in calf that occurs on walking & relieves on rest

  Symptom of peripheral artery disease
• Why is the pain from MI similar to indigestion?

  Cardiac myocytes in the region after occlusion become O2 starved & send pain signals to brain

  Pain feels like indigestion as brain isn't used to this type of pain
• What is angina pectoris?

  Chest pain of cardiac origin
• 25% of people who have an MI are asymptomatic.
• Why do you get chest pain in MI?

  Ischaemia of cardiac myocytes

  Normally 'crushing/stabbing' pain

  NOT relieved with rest
• Why do you get SOB with MI?

  MI → cardiac myocyte death → reduced contractility → decreased CO → less O2 → increased resp rate to compensate
• Why do you get lightheaded/dizzy with MI?

  MI → cardiac myocyte death → reduced contractility → decreased CO & BP → feeling of dizziness
• Why do you get sweating (diaphoresis) with MI?

  MI → cardiac myocyte death → reduced contractility → decreased CO → activation of sympathetic NS → increased adrenaline → activation of sweat glands & ‘fight or flight’ response
• Why do you get nausea & vomiting in MI?

  Toxin release (e.g. lactic acid)
• What are the modifiable RFs of MI?

  Smoking

  Stress

  Inactivity

  Diet

  Obesity

  Diabetes

  Inflammation

  Hyperlipidaemia
• What are the non-modifiable RFs of MI?

  FH

  Age (over 60)

  Sex (Male)

  Genetics
• How does smoking increase the risk of MI?

  Increased risk of atherosclerosis

  Decreased O2 delivery in blood

  Increased thrombogenesis

  Direct coronary artery spasm
• How does stress increase the risk of MI?

  Stress → increased sympathetic NS → increased catecholamines → increased HR, BP & contraction → stimulation of alpha receptors → vasoconstriction → increased arterial pressure → increased risk of plaque rupture
• How does inactivity increase the risk of MI?

  Physical activity = anti-atherosclerotic, antithrombotic, anti-ischaemic & anti-arrhythmic effects

  Regular exercise -> increased cardiorespiratory fitness & lowers myocardial O2 demand

  Sustained physical activity -> lowers BP, reduces lipid levels, increases insulin sensitivity, decreases inflammation, stress & adrenergic activity
• How does diet increase the risk of MI?

  Increased fatty foods → increased cholesterol levels (LDL) → increased likelihood of atherosclerosis → increased risk of MI
• How does obesity increase the risk of MI?

  More adipocytes → more adipokines (+ other chemicals) secreted → highly linked to inflammation and atherosclerosis
• How does diabetes increase the risk of MI?

  Mechanism not fully understood

  May be due to inflammation, endothelial & smooth muscle function, obesity, HTN, dyslipidaemia & hypercoagulability
• How does HTN increase the risk of MI?

  HTN -> ventricular hypertrophy & endothelial dysfunction/damage & promotes atherosclerosis