22. Chest pain Flashcards
Name 6 catastrophic causes of chest pain
acs
aortic dissection
ptx
PE
pericarditis with tamponade
esophageal rupture
Name 8 emergent diagnoses of chest pain
unstable angina
coronary spasm
prinzmetal anginal
cocaine induced per/myocarditis
ptx
mediastinitis
esophageal tear/MW
chole
pancreatitis
Name 8 noneemergent dx of CP
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
CP causes associated with pre/syncope
ao dissection
PE
acute MI
pericarditis
myocarditis
CP conditions assoc with dyspnea
acute MI
coronary ischemia
PE
tension ptx
ptx
unstable angina
pericarditis
CP condition associated with hemoptysis
PE
CP condition assoc with n/v
esophgeal rupture
MI
coronary ischemia
unstable angina
coronary spasm
esophageal tear
chole
Name 8 RF associated with ACS
past or fhx of CAD
men >33/wo >40
dm
htn
cig use/past
elevated LDL/TG
sedentary
obese
postmenopausal
LVH
cocaine abuse
Name 8 RF for PE
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
Name 8 RF for ao dissection
HTN
congenital disease of aorta/aortic valve
inflamm aortic disease
ctd
pregnancy
AS
cig use
Name 8 RF for peri/myocarditis
infection
autoimm like SLE
ARF
recent MI or cardiac surgery
malignancy
rads therapy to mediastinum
uremia
drugs
prior pericarditis
Name 4 RF for ptx
prior ptx
valsalva maneuver
chronic lung disease
cig use
What are signs of MI on exam?
s3-s4 gallop
new murmur
htn/hypot
brady
dipahoresis
jvd
rales
neurologic exam shows signs of stroke
PE findings suggestive of ao dissection
diaphoresis
hypotension (late)
htn early
tachycardia
sign diff upper limb BP
new murmur
focal neuro findings
Which CP conditions is POCUS particularly useful for, per Rosen’s?
pericardial effusion/tamponade, pneumo- thorax, pleural effusion, pulmonary edema, acute coronary syndrome, and PE
Signs of esophageal rupture on XR
pleural effusion
subcut air
mediastinal air fluid level
pneumomediastinum
Name 4 findings on ECG useful for CP diagnosis
new injury
new ischemia
RV strain
dffuse st segment elevation/electrical alternans
Name 6 findings on cxr helpful for dx of CP
ptx with mediastinal shift
wide mediastinum
ptx
effusion
incr cardiac silouette
pneumonmediastinum
CT contrast findings useful for CP dx
intimal aorta tear
clot pulmonary a
esophageal wall edema
pneumomediastinum
periesophgeal fluid
pleural effusion
Name findings of class MI on ECG
stseg elevation >1mm in contiguous leads, new LBBB
q waves >0.04s duration
Name findings of subendocardial infarction on ECG
TWI
STEdepn in concordant leads
Name findings of unstable angina on ECG
N/nonsp
may see TWI
Name findings of classic pericarditis on ECG
diffuse STE
PR segment depression
Name 6 high risk features for suspected CP (but not STEMI)
high risk: elevated trop
new ST decrease 0.5mm
recurrent sichemia
HF with ischemia
depressed LV function
HD instability
PCI last 6mo
prior CABG
IM risk CP: what constitutes this intermediate risk?
> 10 min rest pain - resolved
TWI >2mm
IM trop elevation TNT >0.01mm, <0.1mm
Risk stratification of chest pain - what is considered low risk?
no IM or high risk features
non diagnostic ecg and cardiac markers
age <70
Common additional sx for aortic dissection
Neurologic complications of stroke, peripheral neu- ropathy, paresis or paraplegia, abdominal and extremity isch- emia possible.
Massive PE defn
PE with obstructive shock
sbp <90
submassive PE defn
acutePE without systemic hypotension (sbp is >/=90) but either RV dysfunction or myocardial necrosis
Name 6 different patterns of ecg found in a pe
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
rTPA dose for massive PE
1.5mg/kg
Alteplase dose for PE
100mg (0.6mg/kg) as continuous infusion over 2 hours
Surgical indications in PE - thrombectomy
massive Pe and unresponsive to thrombolysis or CI
R heart cath with clot destruction
IVC filter
