Return to Scenario ListShow Learning Points most relevant to Phase 1:

Acute chest pain

Clinical Discipline(s)/Organ System(s)
Cardiology, Cardiovascular System, Emergency Medicine
Progress Test Topic(s)
Cardiovascular, Seriously ill patient
A 75 year old Māori man presents to the Emergency Department with central chest pain. It has been present for the past 40 minutes and came on while he was resting. He feels terrible.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Anatomy of coronary arteries and veins
   - Physiological changes in cardiac function associated with ageing
   - Pathophysiology of atherosclerosis, plaque rupture and myocardial infarction
   - Changes in cardiac enzymes post-myocardial infarction
   - Pharmacology of glyceryl trinitrate (GTN), aspirin, clopidogrel, statins, low molecular weight heparin, unfractionated heparin, tissue-plasminogen activator, abciximab
   - Mechanism of action and dose-response relationship for beta adrenoceptor blocking drugs; define agonist, antagonist, partial agonist
Clinical and Communication Skills 
   - History from a patient with acute chest pain; consideration of cardiovascular risk factors
   - Examination of the cardiovascular system; recognise signs of cardiogenic shock
   - Differential diagnosis of acute chest pain
   - Perform and interpret an ECG and recognize ischaemic features (i.e. STEMI and NSTEMI)
   - Interpret troponin, cardiac enzymes, C-reactive protein
   - Indications for: echocardiogram, angiography, CT angiogram, exercise tolerance test, dobutamine stress echocardiogram, myocardial perfusion studies
   - Management of acute coronary syndrome (STEMI, NSTEMI and unstable angina)
   - Complications of acute coronary syndrome
   - Role of cardiovascular rehabilitation
   - Management of cardiovascular risk factors post-acute coronary syndrome: pharmacological (including side-effects) and non-pharmacological
   - Outline the management of myocarditis, pericarditis and aortic dissection
Personal and Professional Skills 
   - Awareness of own stress when managing a patient with acute illness
   - Effectively communicate information about lifestyle changes, including smoking cessation
   - Legal requirement for maintaining motor vehicle licences after acute coronary syndromes; issues of confidentiality
Hauora Māori 
   - Awareness of differing risk profiles for cardiovascular disease in Māori (and other disadvantaged populations) compared with non-Māori in New Zealand (higher smoking rates and hypertension, reduced access to primary prevention)
   - Understanding of inequities in cardiovascular disease outcomes for Māori compared with non-Māori including higher incidence of cardiovascular disease and higher mortality; application of this to clinical decision making and management
   - Understanding of inequities in access to health services and quality of medical care for Māori including reduced likelihood of receiving surgical intervention, and application of this to clinical decision making and management
   - Understanding of the role of kaupapa Māori health policies, services and research in reducing inequalities such as the Unequal Treatment Research at Eru Pomare and the Heart Guide Aotearoa service for cardiac rehabilitation
Population Health 
   - Epidemiology of acute coronary syndrome, aortic dissection, pericarditis and myocarditis
   - Access to timely treatment/referral; provision of primary percutaneous coronary intervention for patients in regional-rural locations
   - Screening for risk factors
   - Primary and secondary prevention strategies for coronary artery disease
Conditions to be considered relating to this scenario
acute coronary syndrome (STEMI, NSTEMI and unstable angina), pulmonary embolism, gastro-oesophageal reflux disease, pericarditis, pleuritis, costochondritis, fibromyalgia, hyperventilation syndrome, generalised anxiety disorder, panic attack, depression
Less common but 'important not to miss'
cardiac tamponade, oesophageal rupture, pneumothorax, aortic dissection
achalasia, radiculopathy