| What type of pain is linked to areas above the jaw or below the epigastrium? | Pricking or piercing or stabbing type of pain | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 185 | definition | 1.000 | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • | 1 | page=1,block=7 | 0.700 | valid |
| What is a defining feature of angina in acute coronary syndrome? | lasting more than 20 minutes | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 436 | definition | 1.000 | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • |
| What type of pain is localized to a point? | Pricking or piercing or stabbing type of pain | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 185 | definition | 1.000 | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • |
| What are the characteristics of pain in stable angina? | Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 303 | definition | 1.000 | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • |
| What is the purpose of the exercise treadmill test in the management of cardiovascular events? | Risk stratify by exercise treadmill test in low, intermediate or high risk (DUKE risk score) for cardio-vascular events | 1. Control angina: Metoprolol with/without DHP Ca channel blockers Add nitrates if symptoms not controlled 2. ECG for Q waves, ST - T changes, BBB or chamber enlargement 3. Aspirin & high intensity statins 4. Refer to higher centre electively MANAGEMENT AT DISTRICT HOSPITAL LEVEL 1. Optimise anti-anginal treatment 2. Echocardiography for LV function or structural heart disease 3. Risk stratify by exercise treadmill test in low, intermediate or high risk (DUKE risk score) for cardio-vascular events , if patient is ambulatory and ECG is interpretable 4. Refer to tertiary centres if: • Angina uncontrolled on optimal medical therapy • Echo reveals abnormality • Non-ambulatory patient or un-interpretable ECG • High risk on exercise stress test for possible re-vascularization | 383 | definition | 1.000 | Echocardiography for LV function or structural heart disease 3. Risk stratify by exercise treadmill test in low, intermediate or high risk (DUKE risk score) for cardio-vascular events , if patient is ambulatory and ECG is interpretable 4. | 1 | page=1,block=29 |
| When is the likelihood of diffuse retrosternal pain higher? | if known patient of CAD | • Diffuse retrosternal pain, heaviness or constriction, radiating to arms or neck or back • Associated with sweating • Easily reproduced with post-meal exertion • Consider atypical presentation: Exertional fatigue or breathlessness or profuse sweating or epigastric discomfort Likelihood more if known patient of CAD | 293 | relationship | 0.970 | • Diffuse retrosternal pain, heaviness or constriction, radiating to arms or neck or back • Associated with sweating • Easily reproduced with post-meal exertion • Consider atypical presentation: Exertional fatigue or breathlessness or profuse sweating or epigastric discomfort Likelihood more if known patient of CAD | 1 | page=1,block=4 | 0.700 | valid |
| What type of pain is associated with movement of the neck, arms, or respiration? | Pricking or piercing or stabbing type of pain | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 185 | relationship | 0.970 | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • |
| What should be discussed with high-risk patients about their treatment options? | pros and cons of possible revascularization and dual anti-platelet therapy | Low/ Intermediate Risk Group 1. Optimal anti-anginal therapy 2. Follow up 3-6 monthly at primary/ secondary care centre 3. Refer to tertiary centre when change in symptomatic status High Risk Group 1. Discuss pros and cons of possible revascularization and dual anti-platelet therapy 2. Angiography, if any of following - Angina not controlled on optimal medical therapy - High risk on non-invasive testing - Cardiac arrest survivor or documented VT | 209 | summary | 0.970 | Discuss pros and cons of possible revascularization and dual anti-platelet therapy 2. | 1 | page=1,block=46 | 0.700 | valid |
| What are the characteristics of pain that is variable in location? | Long lasting (hours to days) or short lasting (less than a minute) | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 40 | summary | 0.970 | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • |
| What type of angina is relieved by rest or NTG in 1-2 minutes? | STABLE ANGINA | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 289 | definition | 0.940 | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • |