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Rosens > 22. Chest pain > Flashcards

22. Chest pain Flashcards

1
Q

Name 6 catastrophic causes of chest pain

A

acs
aortic dissection
ptx
PE
pericarditis with tamponade
esophageal rupture

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2
Q

Name 8 emergent diagnoses of chest pain

A

unstable angina
coronary spasm
prinzmetal anginal
cocaine induced per/myocarditis
ptx
mediastinitis
esophageal tear/MW
chole
pancreatitis

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3
Q

Name 8 noneemergent dx of CP

A

valvular heart disease: ao stenosis, mvp
structural hd: hcm
pneumonia
pleuritis, tumor, pneumomediastinum
esophageal spasm
esophageal reflux
peptic ulcer, biliary colic
m strain, rib #, arthrtiis, tumor, costchondritis, nonsp chest wall pain
spinal root compression, thoracic outlet, herpes zoster, postherpetic neuralgia
psych, hyperventilation

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4
Q

CP causes associated with pre/syncope

A

ao dissection
PE
acute MI
pericarditis
myocarditis

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5
Q

CP conditions assoc with dyspnea

A

acute MI
coronary ischemia
PE
tension ptx
ptx
unstable angina
pericarditis

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6
Q

CP condition associated with hemoptysis

A

PE

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7
Q

CP condition assoc with n/v

A

esophgeal rupture
MI
coronary ischemia
unstable angina
coronary spasm
esophageal tear
chole

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8
Q

Name 8 RF associated with ACS

A

past or fhx of CAD
men >33/wo >40
dm
htn
cig use/past
elevated LDL/TG
sedentary
obese
postmenopausal
LVH
cocaine abuse

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9
Q

Name 8 RF for PE

A

malignancy
prolonged immob
surgery >30min in last 3mo
prior DVT/PE
pregnancy/recent pregnancy
pelvic/LE trauma
ocp with cig smoking
chf
copd
obese
pmhx/hx coagulopathy

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10
Q

Name 8 RF for ao dissection

A

HTN
congenital disease of aorta/aortic valve
inflamm aortic disease
ctd
pregnancy
AS
cig use

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11
Q

Name 8 RF for peri/myocarditis

A

infection
autoimm like SLE
ARF
recent MI or cardiac surgery
malignancy
rads therapy to mediastinum
uremia
drugs
prior pericarditis

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12
Q

Name 4 RF for ptx

A

prior ptx
valsalva maneuver
chronic lung disease
cig use

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13
Q

What are signs of MI on exam?

A

s3-s4 gallop
new murmur
htn/hypot
brady
dipahoresis
jvd
rales
neurologic exam shows signs of stroke

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14
Q

PE findings suggestive of ao dissection

A

diaphoresis
hypotension (late)
htn early
tachycardia
sign diff upper limb BP
new murmur
focal neuro findings

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15
Q

Which CP conditions is POCUS particularly useful for, per Rosen’s?

A

pericardial effusion/tamponade, pneumo- thorax, pleural effusion, pulmonary edema, acute coronary syndrome, and PE

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16
Q

Signs of esophageal rupture on XR

A

pleural effusion
subcut air
mediastinal air fluid level
pneumomediastinum

17
Q

Name 4 findings on ECG useful for CP diagnosis

A

new injury
new ischemia
RV strain
dffuse st segment elevation/electrical alternans

18
Q

Name 6 findings on cxr helpful for dx of CP

A

ptx with mediastinal shift
wide mediastinum
ptx
effusion
incr cardiac silouette
pneumonmediastinum

19
Q

CT contrast findings useful for CP dx

A

intimal aorta tear
clot pulmonary a
esophageal wall edema
pneumomediastinum
periesophgeal fluid
pleural effusion

20
Q

Name findings of class MI on ECG

A

stseg elevation >1mm in contiguous leads, new LBBB
q waves >0.04s duration

21
Q

Name findings of subendocardial infarction on ECG

A

TWI
STEdepn in concordant leads

22
Q

Name findings of unstable angina on ECG

A

N/nonsp
may see TWI

23
Q

Name findings of classic pericarditis on ECG

A

diffuse STE
PR segment depression

24
Q

Name 6 high risk features for suspected CP (but not STEMI)

A

high risk: elevated trop
new ST decrease 0.5mm
recurrent sichemia
HF with ischemia
depressed LV function
HD instability
PCI last 6mo
prior CABG

25
Q

IM risk CP: what constitutes this intermediate risk?

A

> 10 min rest pain - resolved
TWI >2mm
IM trop elevation TNT >0.01mm, <0.1mm

26
Q

Risk stratification of chest pain - what is considered low risk?

A

no IM or high risk features
non diagnostic ecg and cardiac markers
age <70

27
Q

Common additional sx for aortic dissection

A

Neurologic complications of stroke, peripheral neu- ropathy, paresis or paraplegia, abdominal and extremity isch- emia possible.

28
Q

Massive PE defn

A

PE with obstructive shock
sbp <90

29
Q

submassive PE defn

A

acutePE without systemic hypotension (sbp is >/=90) but either RV dysfunction or myocardial necrosis

30
Q

Name 6 different patterns of ecg found in a pe

A

N
sinus tach
RBBB
s1,q3,t3
nonsp st change
twi anterior leads (R heart strain)
RAD
S wave in I and aVL >1.5mm
q wave leads III and avF
P pulmonale

31
Q

rTPA dose for massive PE

A

1.5mg/kg

32
Q

Alteplase dose for PE

A

100mg (0.6mg/kg) as continuous infusion over 2 hours

33
Q

Surgical indications in PE - thrombectomy

A

massive Pe and unresponsive to thrombolysis or CI
R heart cath with clot destruction
IVC filter

Rosens (62 decks)

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