Page 27 - Medicine and Surgery

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Cardiovascular system 2

Clinical, 23 Cardiac failure, 61 Hypertension and vascular
Ischaemic heart disease, 32 Disorders of pericardium, diseases, 73
Rheumatic fever and valve myocardium and Congenital heart disease, 84
disease, 40 endocardium, 65 Cardiovascular oncology, 88
Cardiac arrhythmias, 48

The pain of chronic stable angina is brought on by

Clinical exercise or emotion, and it is usually relieved within
2–3minutesbyrestandrelaxation.Ittendstobeworse
in cold weather or after meals. It may be associated
Symptoms
with shortness of breath. Sublingual glyceryl trinitrate
(GTN), which dilates the coronary arteries, should
Cardiovascular chest pain
also rapidly relieve it.
Chest pain can arise from the cardiovascular system, the Angina that occurs at rest or is provoked more easily
respiratory system, the oesophagus or the musculoskele- than usual for the patient is due to acute coronary syn-
tal system. The major causes of chest pain in the car- drome (see page 36). It often persists for longer and
diovascular system include ischaemia, pericarditis and although it may respond to GTN, it tends to recur.
aortic dissection. In acute coronary syndrome it is not possible to dif-
Enquire about chest pain ask about the site, nature ferentiate angina from myocardial infarction without
(constricting, sharp, burning, tearing), radiation, pre- further investigations.
cipitating/relieving factors and any associated symp- Inmyocardialinfarctionthepainbearsnorelationship
toms.Askalsoaboutthetimecourse,i.e.onset,duration, to exertion. Typically the pain has the same character,
constant or episodic. SOCRATES may be used as a but it is more severe and unrelieved except by opiate
mnemonic: analgesia. Features suggestive of myocardial infarction
Site rather than angina include pain, which lasts longer

Onset than 30 minutes, associated symptoms due to the re-

Character lease of catecholamines including sweating, dizziness,

Radiation nausea and vomiting. Some patients describe a feeling

Alleviating factors of impending doom (angor animi).

Time course Pericarditis causes a sharp or aching pain. It is a ret-

Exacerbating factors rosternal or epigastric pain that radiates to the neck,

Symptoms associated with the pain back or upper abdomen. The pain is usually altered in

Ischaemic heart pain is classically a central aching chest severity in relation to posture, typically exacerbated by
pain, often described as a tightness or heaviness, con- deep inspiration or lying flat and relieved by leaning for-
stricting or crushing in nature, radiating into the arms wards. The pain of pericarditis may last days or even 2–3
(particularly the left) and jaw. However, this varies be- weeks.
tween individuals and therefore the pattern of pain is Aortic dissection causes a very severe central tearing
very significant. chest or abdominal pain that radiates through to the

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