7 Deadly Chest Pain Flashcards
1
Q
Somatic vs. Visceral pain
A
Somatic
- Easily described
- Precisely located
- Usually sharp
Visceral
- Difficult to describe
- Poorly localized
- Usually dull, heavy, or aching
2
Q
Initial approach to chest pain
A
- ABCDE
- OMMILTVS
- EKG (<10 min interpretation)
- Hx
3
Q
7 Deadly chest pains
A
- MI
- Aortic Dissection
- Cardiac Tamponade
- Esophageal Rupture
- Pneumonia
- Pulmonary Embolism
- Pneumothorax
4
Q
Acute MI
- pathophys
A
Atherosclerotic plaque rupture → platelet thrombus formation → decreased coronary blood flow → ischemia → infarction
5
Q
Acute MI
- RCA
A
Inferior Wall
Leads: II, III, AVF
6
Q
Acute MI
- LAD
A
Anterior Wall
Leads: V1-V6
7
Q
Acute MI
- Circuflex
A
Lateral Wall
Leads: I, AVL, V5, V6
8
Q
Acute MI Risk factors
A
- Hyperlipidemia
- Diabetes
- Obesity
- Atherosclerosis
9
Q
Acute MI
s/sx
A
- Chest pain
- Diaphoresis
- SOB
- Referred pain to neck/shoulder/arm
- +/- N/V
- +/- tachycardia
- +/- pallor
10
Q
Acute MI
- Labs and Imaging
A
- CBC: H&H and platelets can help determine bleeding status
- CMP
- PT/INR
- Troponin
- EKG
- CXR
11
Q
Acute MI
- Dx
A
- Chest pain or MI symptoms
EKG:
- 1 mm ST elevation in contiguous limb leads
- 2 mm ST elevation in contiguous precordial leads
- If ischemia present on EKG, look at opposite leads for infarct (ST elevation)
12
Q
Acute MI
- Tx
A
- O2: Pulse ox < 94
- ASA
- Beta blocker
- +/- Nitro: Can use as long as systolic BP > 90
- Anticoagulation
- Glycoprotein IIb/IIIa inhibitors
- Reperfusion: PCI or thrombolytics
13
Q
Aortic Dissection
- Pathophys
A
Violation of intima allows blood to dissect between intimal and adventitial layers of aorta
14
Q
Aortic Dissection
- RF
A
- HTN
- Pregnancy
- MVA
- Connective tissue disorders: Marfan and Ehlers-Danlos **
15
Q
Aortic Dissection
- S/Sx
A
- Tearing/ripping chest pain: Radiates to back
- Hypotension
- +/- neuro symptoms
16
Q
Aortic Dissection
- Labs/imaging
A
- CBC
- PT/INR
- Blood type and crossmatching
- EKG
- CXR
17
Q
Aortic Dissection
- Dx
A
- CXR, CT, or TEE (transesophageal echo)
- Widened mediastinum
18
Q
Aortic Dissection
- Tx
A
- BP management: fluids, negative inotropic agent, vasodilator
- +/- surgical repair
19
Q
Cardiac Tamponade
- Pathophys
A
- Increased fluid in pericardial sac causes restricted ventricular filling
- Intrapericardial pressures exceed normal filling pressures of R heart
20
Q
Cardiac Tamponade
- RF
A
- Trauma
- SLE
- Malignancy
- Dialysis
21
Q
Cardiac Tamponade
- S/Sx
A
Beck’s Triad
- JVD
- Hypotension
- Muffled heart sounds
22
Q
Cardiac Tamponade
- Dx
A
- ECHO** (GS)
- EKG: Electrical alternans
- CXR: Water bottle heart
23
Q
Cardiac Tamponade
- Tx
A
- Volume expansion
- Pericardiocentesis
24
Q
Esophageal Rupture
- RF
A
- Alcoholism
- Frequent vomiting
- GERD
- Barrett’s esophagus
- Malignancy
25
Esophageal Rupture
| - Causes
- Iatrogenic
- Boerhaave syndrome: transmural perforation associated with vomiting
- Trauma
- Foreign body
26
Esophageal Rupture
| - s/sx
- Hamman crunch (auscultation sound)
| - Subcutaneous emphysema
27
Esophageal Rupture
| - Labs/imaging
PT/INR
28
Esophageal Rupture
| - Dx
CT with water soluble contrast
29
Esophageal Rupture
| - Tx
- Resuscitation
- Abx
- Sx repair
30
Pneumonia
| - pathophys
Infection in the gas exchange portions of lungs
31
Pneumonia
| - RF
age extremes
32
Pneumonia
| - S/sx
- Chest pain
- SOB, Dyspnea
- Cough, sputum production
- Fever, chills, rigor
- Hypoxia
- Tachycardia, tachypnea
33
Pneumonia
| - Dx
- Abnormal lung exam
| - CXR with infiltrate**
34
Pneumonia
| - Tx
- O2
- Blood/sputum cultures
- Abx: Vancomycin, Rocephin (ceftriaxone)
- Bronchodilators: albuterol, ipratropium
- Chest percussion therapy (CPT)
35
Pulmonary Embolism
| - pathophys
- **Virchow’s Triad for Thrombosis Formation
1. Endothelial injury
2. Stasis of blood flow
3. Hypercoagulability
- Proximal portion of venous clot dislodged
- Travels through veins to R ventricle
- Becomes lodged in pulmonary arteries
36
Pulmonary Embolism
| - RF
- Recent surgery
- Recent trauma w/ fracture
- Recent hospitalization
- Prolonged sedentary state
- Birth control
- Hx of DVT
- Hypercoagulable state: Pregnancy, Factor V Liden, Protein S
37
Pulmonary Embolism
| - S/sx
- SOB
- chest pain
- dyspnea
38
Pulmonary Embolism
| - Dx
- CT Angiography** (GS)
- D-dimer (screening)
- Ventilation perfusion scan
39
Pulmonary Embolism
| - Tx
- Anticoagulation
- Thrombolytics
- Clot retrieval
40
Pneumothorax
| - pathophys
Air enters potential space between parietal and visceral pleura
41
Pneumothorax
| - RF
- Trauma: MVA MC cause
- Tall, thin frame
- Smoker
- Young
42
Pneumothorax
| - S/sx
- Chest pain
- SOB
- Dyspnea
- Subcutaneous emphysema
- Displaced trachea/mediastinum
43
Pneumothorax
| - Dx
CXR: except tension pneumonia
44
Pneumothorax
| - Tx
- O2
- Needle decompression
- Thoracostomy tube
- Cardiovascular surgery: Definitive treatment for prevention of recurrence
