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CRAAB 4 > Adams: Chest Pain > Flashcards

Adams: Chest Pain Flashcards

1
Q

What is the differential for chest pain?

A 
Anxiety
aortic stenosis
asthma
cardiomyopathy
esophagitis
gastroenteritis
hypertensive emergency
myocarditis
pericarditis
cardiac tamponade
aortic dissection
pulmonary embolism
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2
Q

What is the classical presentation for chest pain?

A
  1. Pt presents in AM with substernal achy pressure pain that radiates to anterior neck, shoulders, left arm and back.
  2. SOB
  3. Nausea
  4. Diaphoresis
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3
Q

What percentage of patients have “chest pain”

A

about 50%

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4
Q

What are risk factors for chest pain?

A 
past hx of CAD
smoker
HTN
elevated cholesetrol
diabetes
family hx of coronary disease
(father< 55, mother < 65)
elevated CRP
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5
Q

What population often presents with atypical symptoms such as: SOB, syncope, stroke, palpitation, indigestion, weakness?

A

women

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6
Q

What is UA/NSTEMI?

A

Unstable angina/non ST elevation myocardial infarction

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7
Q

What is STEMI?

A

ST elevation myocardial infarction

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8
Q

What is angina?

A

When oxygen demand is greater than the oxygen being delivered to the cardiac muscle. It leads to ischemia.

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9
Q

How long does angina usually last?

A

Less than 30 mins

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10
Q

What is stable angina?

A

Can be frequent and still STABLE

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11
Q

What is prinzmetal’s angina?

A

occurs at rest, often at night, and rarely with exercise

Vasospasm
associated with ST elevations

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12
Q

What is unstable angina?

A
  1. Increased duration, frequency and intensity of angina
  2. new associated symptoms
  3. occurs with increasingly less activity or at rest.
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13
Q

Why do you need to be worried about unstable angina?

A

10% of people will have an MI in 7 days

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14
Q

How is angina graded?

A

I-IV

I- ordinary physical activity doesn’t cause it only strenuous
II- slight limitation of ordinary activity
III- marked limitations of ordinary physical activity
IV- inability to carry on any physical activity without discomfort, may be present at rest

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15
Q

What is the criteria for defining an MI?

A

Elevated troponin and at least one of the following:

  1. sxs of ischemia
  2. Q wave development
  3. New ST/T wave changes/new LBBB
  4. intracoronary thrombus
  5. Loss of cardiac wall
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16
Q

What percent of MIs have normal EKGs?

A

1/3!

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17
Q

Why is a posterior MI unique?

A

It is the BACK of the heart so ST elevations actually appear as depressions.

18
Q

What does a STEMI look like on an EKG?

A

Greater than 1 BOX in all leads excepts V2/V3 it must be greater than 2 boxes.

19
Q

What does an NSTEMI look like on an EKG?

A
  1. Horizontal or downward sloping ST depression in 2 leads

AND/OR

  1. T wave inversion with prominent R wave in 2 leads
20
Q

How long does troponin last after an MI?

A

Up to 2 weeks

21
Q

What is there the lowest sensitivity for troponin after an MI?

A

only 50% at 3 hrs

22
Q

What will give a false positive on a troponin test?

A

atrial fib
sepsis
chronic kidney disease

23
Q

What is CPK MB a sign of?

A

Reinfarction

24
Q

When might you rule out cardiac disease?

A
  1. normal EKG (or no change)
  2. cardiac enzymes
  3. another plausible diagnosis
25
Q

What is the most important consideration when making a diagnosis of MI?

A

the HISTORY

26
Q

What is low risk management of ACS?

A

ASA

observation w/ repeat troponin in 6-12 hrs

27
Q

What is moderate to high risk management for ACS?

A

nitro
heparin
repeat troponin 6-12 hrs

28
Q

What is used to treat a UA/NSTEMI?

A

PCI (percutaneous coronary intervention –better than TPA)

medications

29
Q

What is used to treat a STEMI?

A
  1. fibrinolytics (tpa, reteplase)
  2. PCI w/ dilation and stinting
  3. CABG
  4. medications
30
Q

When do you use oxygen?

A

If pt is hypoxic and O2 sat is <94%.

**It can be dangerous to give O2 to a NORMOXIC pt

31
Q

When do you use nitro?

A

Angina and selectiely MI

32
Q

What do you not want to use nitro to treat? Why?

A

RIGHT ventricular infarct (occurs in 50% of inferior MIS)

It reduces preload and causes BP to drop

33
Q

When do you use morphine?

A

For pain that is unresponsive to nitro and is a stopgap.

It can cause hypotension.

34
Q

What is the best drug used to treat MI?

A

Aspirin!!

35
Q

What does aspirin do?

A

It’s an antiplatelet!

36
Q

What should be given to a pt w/ MI if they can’t take aspirin?

A

Clopidogel

Used in all pt less than 75 yrs with UA/NSTEMI or STEMI

37
Q

What does clopidogel do?

A

Inhibits ADP dependent activation of GpIIb/IIIa complex ( a necessary step for platelet aggregation)

38
Q

What anticoagulents are used for MI?

A
  1. UFH
  2. Enoxaparin
  3. Fondaparinux
  4. Bivalirudin (direct thrombin inhibitor)
39
Q

When are glycoprotein IIb/IIIa inhibitors used? What do they do?

A

In conjunction with PCI

They inhibit the integrin GPIIb/IIIa receptor in the platelet membrane and inhibt the final common pathway to activation of platelet aggregation.

40
Q

What are common Glycoprotein inhibitors?

A

abciximab
eptifibatide
tirofiban

41
Q

What drug is important to use in the first 24 hours in pts with CHF or LV ejection < 40% and no hypotension?

A

ACE inhibitors

42
Q

What drug can cause an 11% reduction in mortality if used in the first 24 hours following MI?

A

Beta blockers

CRAAB 4 (5 decks)

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