An introduction to Chest pain ‘how to mend a broken heart’
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Transcript of An introduction to Chest pain ‘how to mend a broken heart’
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An introduction to Chest pain
‘how to mend a broken heart’
![Page 2: An introduction to Chest pain ‘how to mend a broken heart’](https://reader035.fdocuments.net/reader035/viewer/2022062407/56649d745503460f94a541bd/html5/thumbnails/2.jpg)
Case 1
• 55 year old accountant
• Stressed in a meeting at work
• Sudden onset chest pain
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Crushing chest pain…
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ECG
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Coronary artery thrombus
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Immediate treatment
• Oxygen
• Analgesia
• Aspirin
• Thrombolysis ‘clot busting drugs’
• Primary angioplasty ‘hot wiring’
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Another Case
• Reg G 61 year old retired suffolk farmer
• Osteoarthritis hip• Undergoes total hip
replace (THR)
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4 days post-op
• Initially making good recovery
• Sudden onset SOB and sharp ‘stabbing’ chest pain on commode in the evening
• O2 sats 89% on air
• Pulse 130 bpm irregularly irregular
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What may have happened?
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Immediate investigations
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ECG
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Immediate management
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D-Dimer
• Specific degradation product released into circulation when cross-linked fibrin undergoes endogenous fibrinolysis
• Low D-dimer has high negative predictive value
• Non-specific elevation in sepsis, pregnancy, MI and post surgery
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CXR
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Imaging
• CXR – to exclude other causes• CTPA
– CT chest– Give iv iodine and time to fill pulmonary
arteries– Arm vein -> RA -> RV -> PA
• Contrast can– Cause allergic reaction– Damage kidneys
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What are we looking for?
Ab
Ab
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Imaging – Pulmonary angiogram
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Treatment
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Treatment
• Oxygen to correct hypoxia
• LMWH – dose according to weight
• Commence warfarin loading
• 6 months treatment with warfarin
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What would you warn Reg about the risks of treatment?
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Case 3 – Mr AL
• 21 year old man
• Known Marfan’s disease
• Previous aortic valve replacement
• Acutely SOB
• R-sided chest pain
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Examination findings
• In pain and distressed
• RR 30 / min
• Oxygen saturation 85% on air
• Hyper-resonant over R lung field
• Increased SOB
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Radiology
Right lung:– Black– No
markings– No
mediastinal shift
Sternal wires
Heart valve
Pleura
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Treatment
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Further radiology – post chest drain
Pleura
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What does the future hold
• Must not scuba dive
• High chance of recurrence if at increased altitude – no flying for at least 1/12
• Chance of recurrent pneumothorax high
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Any questions?