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ER 2 > 7 Deadly Chest Pain > Flashcards

7 Deadly Chest Pain Flashcards

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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
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2
Q

Initial approach to chest pain

A
  • ABCDE
  • OMMILTVS
  • EKG (<10 min interpretation)
  • Hx
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3
Q

7 Deadly chest pains

A
  1. MI
  2. Aortic Dissection
  3. Cardiac Tamponade
  4. Esophageal Rupture
  5. Pneumonia
  6. Pulmonary Embolism
  7. Pneumothorax
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4
Q

Acute MI

- pathophys

A

Atherosclerotic plaque rupture → platelet thrombus formation → decreased coronary blood flow → ischemia → infarction

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5
Q

Acute MI

- RCA

A

Inferior Wall

Leads: II, III, AVF

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6
Q

Acute MI

- LAD

A

Anterior Wall

Leads: V1-V6

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7
Q

Acute MI

- Circuflex

A

Lateral Wall

Leads: I, AVL, V5, V6

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8
Q

Acute MI Risk factors

A
  • Hyperlipidemia
  • Diabetes
  • Obesity
  • Atherosclerosis
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9
Q

Acute MI

s/sx

A
  • Chest pain
  • Diaphoresis
  • SOB
  • Referred pain to neck/shoulder/arm
  • +/- N/V
  • +/- tachycardia
  • +/- pallor
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10
Q

Acute MI

- Labs and Imaging

A
  • CBC: H&H and platelets can help determine bleeding status
  • CMP
  • PT/INR
  • Troponin
  • EKG
  • CXR
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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)
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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
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13
Q

Aortic Dissection

- Pathophys

A

Violation of intima allows blood to dissect between intimal and adventitial layers of aorta

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14
Q

Aortic Dissection

- RF

A
  • HTN
  • Pregnancy
  • MVA
  • Connective tissue disorders: Marfan and Ehlers-Danlos **
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15
Q

Aortic Dissection

- S/Sx

A
  • Tearing/ripping chest pain: Radiates to back
  • Hypotension
  • +/- neuro symptoms
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16
Q

Aortic Dissection

- Labs/imaging

A
  • CBC
  • PT/INR
  • Blood type and crossmatching
  • EKG
  • CXR
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17
Q

Aortic Dissection

- Dx

A
  • CXR, CT, or TEE (transesophageal echo)

- Widened mediastinum

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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
Q

Esophageal Rupture

- Causes

A
  • Iatrogenic
  • Boerhaave syndrome: transmural perforation associated with vomiting
  • Trauma
  • Foreign body
26
Q

Esophageal Rupture

- s/sx

A
  • Hamman crunch (auscultation sound)

- Subcutaneous emphysema

27
Q

Esophageal Rupture

- Labs/imaging

A

PT/INR

28
Q

Esophageal Rupture

- Dx

A

CT with water soluble contrast

29
Q

Esophageal Rupture

- Tx

A
  • Resuscitation
  • Abx
  • Sx repair
30
Q

Pneumonia

- pathophys

A

Infection in the gas exchange portions of lungs

31
Q

Pneumonia

- RF

A

age extremes

32
Q

Pneumonia

- S/sx

A
  • Chest pain
  • SOB, Dyspnea
  • Cough, sputum production
  • Fever, chills, rigor
  • Hypoxia
  • Tachycardia, tachypnea
33
Q

Pneumonia

- Dx

A
  • Abnormal lung exam

- CXR with infiltrate**

34
Q

Pneumonia

- Tx

A
  • O2
  • Blood/sputum cultures
  • Abx: Vancomycin, Rocephin (ceftriaxone)
  • Bronchodilators: albuterol, ipratropium
  • Chest percussion therapy (CPT)
35
Q

Pulmonary Embolism

- pathophys

A
  • **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
Q

Pulmonary Embolism

- RF

A
  • 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
Q

Pulmonary Embolism

- S/sx

A
  • SOB
  • chest pain
  • dyspnea
38
Q

Pulmonary Embolism

- Dx

A
  • CT Angiography** (GS)
  • D-dimer (screening)
  • Ventilation perfusion scan
39
Q

Pulmonary Embolism

- Tx

A
  • Anticoagulation
  • Thrombolytics
  • Clot retrieval
40
Q

Pneumothorax

- pathophys

A

Air enters potential space between parietal and visceral pleura

41
Q

Pneumothorax

- RF

A
  • Trauma: MVA MC cause
  • Tall, thin frame
  • Smoker
  • Young
42
Q

Pneumothorax

- S/sx

A
  • Chest pain
  • SOB
  • Dyspnea
  • Subcutaneous emphysema
  • Displaced trachea/mediastinum
43
Q

Pneumothorax

- Dx

A

CXR: except tension pneumonia

44
Q

Pneumothorax

- Tx

A
  • O2
  • Needle decompression
  • Thoracostomy tube
  • Cardiovascular surgery: Definitive treatment for prevention of recurrence

ER 2 (10 decks)

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