ACUTE CORONARY SYNDROME EXAM 2024/2025 WITH
100% ACCURATE SOLUTIONS
What is the clinical manifestation of Obstructive Coronary Artery Disease (CAD)?
- Precise Answer ✔✔Cardiac chest pain
Visceral pain - described as a band around the chest tightening, an elephant sitting
on the chest, or something reaching in and grabbing inside the chest (devil's grip).
More of a pressure symptom.Very strange discomfort. - Precise Answer
✔✔Anginal CP description
Visceral pain comes from a general pool of nerves. This is why the pain radiates,
and patient feels is elsewhere. Commonly, towards the side of the chest, up the
neck, side of the arm, the back, or bilateral shoulders. Could also be epigastric.
Must keep a high index of suspicion when pain is so diffused. Test em' all - Precise
Answer ✔✔Chest pain syndrome
Angina due to PARTIAL CAD obstruction. Commonly chronic and exertional.
Stable frequency of recurrence. No variation in intensity. Relieved with rest or
typical nitroglycerine use pattern. Not associated with hemodynamuc or acute
cardiac compromise. No ECG findings of acute ischemia or changes from baseline.
Again, due to chronic PARTIAL CAD obstruction supplying viable tissue, not scar
from old MI. May occur from multiple vessels or post Percutaneous coronary
intervention (PTCA or angioplasty) and CABG due to incomplete
revascularization. - Precise Answer ✔✔Stable angina
NEW ONSET. Increase in pattern of recurrence. Increased intensity. Not relieved
with rest or usual pattern of NTG. Associated with hemodynamic or cardiac
compromise. Emergency situation. Associated with a NEW PARTIAL CAD
OBSTRUCTION. NOT associated with permanent myocardial damage. - Precise
Answer ✔✔Unstable angina (UA)
, VASOSPASTIC CAP. transient paroxysmal vasoconstriction. Classically "usually
not associated with fixed obstructive atherosclerotic CAD". With atherosclerotic
disease, any endothelial damage may result in vasospasm of the vessel due to
reduced NO. Coronaries respond to NTG (NO donor), and small vessels respond to
CaCB better. ECG paradoxical upright T waves or ST increase. More common in
women less than 50. Chronic treatment with CaCB. Avoid beta blocker
(unopposed alpha). - Precise Answer ✔✔Prinzmetal angina
Take home message: only 30% of presentations is actually cardiac pain. - Precise
Answer ✔✔Clinical CP presentation
PE
Pneumothorax
Aortic dissection
Acute myocardial Infarction/Angina
Pericarditis
Oesophageal rupture/spasm
Pneumonia
Pleurisy/Pleural effusion
Bone mets
Rib fracture
Costochondritis
Shingles
Anxiety → diagnosis of exclusion (Adrenaline production → HR elevates → chest
muscles contract → CP) - Precise Answer ✔✔CP DDx
- Precise Answer ✔✔Clinical Approach to CP
100% ACCURATE SOLUTIONS
What is the clinical manifestation of Obstructive Coronary Artery Disease (CAD)?
- Precise Answer ✔✔Cardiac chest pain
Visceral pain - described as a band around the chest tightening, an elephant sitting
on the chest, or something reaching in and grabbing inside the chest (devil's grip).
More of a pressure symptom.Very strange discomfort. - Precise Answer
✔✔Anginal CP description
Visceral pain comes from a general pool of nerves. This is why the pain radiates,
and patient feels is elsewhere. Commonly, towards the side of the chest, up the
neck, side of the arm, the back, or bilateral shoulders. Could also be epigastric.
Must keep a high index of suspicion when pain is so diffused. Test em' all - Precise
Answer ✔✔Chest pain syndrome
Angina due to PARTIAL CAD obstruction. Commonly chronic and exertional.
Stable frequency of recurrence. No variation in intensity. Relieved with rest or
typical nitroglycerine use pattern. Not associated with hemodynamuc or acute
cardiac compromise. No ECG findings of acute ischemia or changes from baseline.
Again, due to chronic PARTIAL CAD obstruction supplying viable tissue, not scar
from old MI. May occur from multiple vessels or post Percutaneous coronary
intervention (PTCA or angioplasty) and CABG due to incomplete
revascularization. - Precise Answer ✔✔Stable angina
NEW ONSET. Increase in pattern of recurrence. Increased intensity. Not relieved
with rest or usual pattern of NTG. Associated with hemodynamic or cardiac
compromise. Emergency situation. Associated with a NEW PARTIAL CAD
OBSTRUCTION. NOT associated with permanent myocardial damage. - Precise
Answer ✔✔Unstable angina (UA)
, VASOSPASTIC CAP. transient paroxysmal vasoconstriction. Classically "usually
not associated with fixed obstructive atherosclerotic CAD". With atherosclerotic
disease, any endothelial damage may result in vasospasm of the vessel due to
reduced NO. Coronaries respond to NTG (NO donor), and small vessels respond to
CaCB better. ECG paradoxical upright T waves or ST increase. More common in
women less than 50. Chronic treatment with CaCB. Avoid beta blocker
(unopposed alpha). - Precise Answer ✔✔Prinzmetal angina
Take home message: only 30% of presentations is actually cardiac pain. - Precise
Answer ✔✔Clinical CP presentation
PE
Pneumothorax
Aortic dissection
Acute myocardial Infarction/Angina
Pericarditis
Oesophageal rupture/spasm
Pneumonia
Pleurisy/Pleural effusion
Bone mets
Rib fracture
Costochondritis
Shingles
Anxiety → diagnosis of exclusion (Adrenaline production → HR elevates → chest
muscles contract → CP) - Precise Answer ✔✔CP DDx
- Precise Answer ✔✔Clinical Approach to CP
