Chest pain

The aim of this topic is to review the pathological basis of chest pain. While ischaemic heart disease will be emphasised, other conditions such as pneumonia, pulmonary infarction, aortic dissection, pericarditis and chest wall pain should be considered.

Learning objectives:

At the completion of this topic you should be able to:

  1. Describe the events that may lead to occlusion in the coronary circulation, and recognise the macroscopic and microscopic changes that may occur in the myocardium as a result of such an event.
  2. Describe the typical clinical syndromes of chest pain, including ischaemic, pleuritic, chest wall and radicular pain, and indicate their pathological and anatomical basis.
  3. Discuss the epidemiology of ischaemic heart disease and the morbidity and mortality produced as a result of this disease.
  4. Outline the common sites of coronary artery atherosclerosis, and describe the relationship between the complications of atherosclerosis and the clinical syndromes of stable and unstable angina.
  5. Relate these same changes in the myocardium to the electrocardiographic abnormalities that characterise myocardial infarction.
  6. Describe the way in which estimation of blood enzyme levels may aid in the diagnosis of myocardial infarction. In particular, outline the time course of changes in serum creatine kinase levels following myocardial infarction.
  7. Describe in detail the common complications of myocardial infarction, and their pathological basis. In particular, describe the mechanisms responsible for ventricular and other arrhythmias, cardiogenic shock and cardiac failure, cardiac rupture, pericarditis and pulmonary thromboembolism.
  8. Discuss the common causes, typical pathological changes, and clinical consequences of aortic dissection.
  9. List the causes of pericarditis, and outline the clinical features and potential complications of this condition.
  10. Describe the investigations that may elucidate the cause of a pleural effusion.

Trial exam questions:

  1. Compare and contrast the pathogenesis of typical angina pectoris, unstable angina and myocardial infarction.
  2. Write brief notes on the early and delayed complications of myocardial infarction.
  3. Discuss the pathophysiology of myocardial "reperfusion injury". How does it differ from "stunned myocardium"?

Case protocol associated with this topic - 9

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