Typical patient- Middle-aged (male) or elderly (either sex), often with a family history of coronary heart disease and one or more of the major reversible risk factors (smoking, hypertension, hypercholesterolaemia)
- In many patients there is no preceding history of angina
Major symptoms- Chest pain and shortness of breath. Pain usually prolonged and often described as 'heaviness' or 'tightness', with radiation into arms, neck or jaw. Alternative descriptions include 'congestion' or 'burning', which may be confused with indigestion
Major signs- Ischaemic myocardial damage, fourth heart sound, dyskinetic precordial impulse
- Autonomic disturbance, tachycardia (anterior MI), bradycardia (inferior MI), sweating, vomiting, syncope
Diagnosis- Markers of injury: raised CKMB and troponins
- ECG: may be normal or show ST depression or T-wave change (non-ST elevation myocardial infarction). ST elevation myocardial infarction denotes higher risk
Additional investigations- Biochemistry: blood sugar and lipids to rule out diabetes and dyslipidaemia
- Risk stratification: echocardiogram (LV function) and stress testing (reversible ischaemia)
Comments- History and troponin testing most useful diagnostic tools
Rare cardiovascular causes of chest pain include mitral valve disease associated with massive left atrial dilatation. This causes discomfort in the back, sometimes associated with dysphagia due to oesophageal compression. Aortic aneurysms can also cause pain in the chest owing to local compression.
Posts
No comments:
Post a Comment