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Clin Assess CV > Assessment of CP > Flashcards

Assessment of CP Flashcards

1
Q

What are the common etiologies of CP?

A 
Angina
MI
Pericarditis
Dissection Aortic Aneurysm
Pleuritic pain
Radiating pain from other causes
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2
Q

What is the first step in assessing chest pain?

A

Quantify the pain

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3
Q

If you have a patient with a tearing, shearing pain radiating to the back, what should you think of immediately?

A

Aortic dissection! Until proven otherwise

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4
Q

What type of chest pain is typically sharp, stabbing, unilateral, and made worse with a deep breath?

A

Pleuritic pain

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5
Q

What is pleuritic pain associated with?

A

Fever, cough, SOB, infectious process like pneumonia

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6
Q

What causes the chest pain of angina?

A

Due to ischemia of the heart muscle - usually spasm of coronary arteries

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7
Q

If your patient presents with chest tightness or constricting pain, and says they have an “elephant sitting on their chest” what should you think?

A

Angina

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8
Q

Who might have atypical presentations of angina?

A

Women and diabetics

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9
Q 
Dull
Tight
Pressing
Squeezing
Burning
Heaviness
Band across the chest
Weight in center of chest
A

Angina symptoms

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10
Q

What are some associated symptoms of angina?

A

Dyspnea, radiation, pain during exertion that abates with rest, exacerbating factors like cold, heavy meals and emotion

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11
Q

What are the some relieving factors for angina?

A

Rest and nitrates

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12
Q

If your patient is having new onset chest pain that occurs with minimal exertion and does not get better with rest that is increasing in intensity, what type of angina do they have?

A

Unstable!

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13
Q

Unstable angina is associated with??

A

Ruptured plaques and thrombi, causing obstruction

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14
Q

Stable angina is associated with?

A

Chronic stable coronary stenosis

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15
Q

What provokes chronic stable angina?

A

Exertion

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16
Q

What are the angina equivalents that a patient may have that could clue you in to CVD or an MI?

A

Dyspnea, indigestion, weakness, malaise

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17
Q

Who is more likely to present with angina equivalents?

A

Women

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18
Q

What condition would give a patient tearing pain that lasts for hours and gets worse with changing body positions and breathing?

A

Pericarditis

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19
Q

Which disorders put a patient at risk for pericarditis?

A

Lupus, RA, kidney failure, cancer, trauma

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20
Q

What will relieve the pain of pericarditis? What makes it worse?

A

Leaning forward

Laying down

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21
Q

What is important during your exam to identify pericarditis?

A

History of recent illness

Friction rub on auscultation

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22
Q

What type of imaging should you use to distinguish pericarditis from and MI?

A

ECHO

Can mimic MI on ECG

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23
Q

What is Beck’s triad?

A

Helps identify cardiac tamponade

Low BP
Distended neck veins
Muffled heart sounds

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24
Q

What is a complication of pericarditis that results from the buildup up pressure from fluid in the pericardial sac that restricts the blood returning to the heart?

A

Cardiac tamponade

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25
Q

How do you know if someone is having an aortic dissection?

A

BP is different on left and right side

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26
Q

What could an aortic dissection be confused with?

A

MI, esophagitis, or pericarditis

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27
Q

Which pulses will be lost on the left or right side with an aortic dissection?

A

Radial, femoral, pedal pulses will be different

28
Q

Where will you hear a heart murmur for a patient having an aortic dissection?

A

Usually aortic valve

29
Q

What causes paralysis or stroke during a dissection?

A

Blood vessels exiting the aorta are damaged

30
Q

What risk factors should you ask about when obtaining a history for chest pain?

A

CAD - HTN, smoking, hyperlipidemia, diabetes, family history

31
Q

What risk factors should you ask about for PE?

A 
Recent surgery
Fractures
Prolonged inactivity (long flights or bed rest)
OCP
Cancer
32
Q

What are some risk factors you should ask about when assessing for an aortic dissection?

A 
HTN
Marfans syndrome
Ehlers-Danlos syndrome
Polycystic kidney disease
Pregnancy
Cocaine use
33
Q

Extreme laxity of joints

A

Ehlers-Danlos syndrome

34
Q

What is the sequence of exam when auscultating the heart for chest pain?

A

Supine with head of bed at 30 degrees
Left lateral decubitus
Sitting, leaning forward

35
Q

S1 results from?

A

Closure of mitral valve

36
Q

Where is S1 the loudest?

A

Apex fo heart

37
Q

S2 results from?

A

Closure of aortic valve

38
Q

Where is S2 the loudest?

A

Base of heart

39
Q

When will you hear A2 and P2? What is it?

A

Heard during inspiration, splitting of S2

40
Q

Caused by abrupt acceleration of inflow across mitral valve?

A

S3 “gallop”

41
Q

Caused by increased LV and diastolic stiffness

A

S4

42
Q

S3 and S4 are highly correlated with?

A

HF and MI

43
Q

When do you use the diaphragm to auscultate?

A

High-pitched S1 and S2
Aortic and Mitral regurg
Pericardial friction rub

44
Q

When do you use the bell to auscultate?

A

Low pitched S3 and S4

Mitral stenosis murmer

45
Q

What is the grading scale for a murmer?

A

1-6

6 = very loud!

46
Q

What can you find on a skin exam of someone with hypercholesterolemia?

A

Xanthomas

47
Q

What cardiac biomarkers are released with myocardial cell death?

A

Troponins and CK-MB

48
Q

What is the preferred biomarker for assessing an AMI because it is more specific and sensitive?

A

Troponin

49
Q

If you have a patient with CP and no elevation of Troponin or CK-MB, can you diagnose them with an AMI??

A

No! Elevation of troponin or CK-MB is required for diagnosis of AMI

50
Q

When should you check the troponin on a patient with chest pain?

A

At first presentation
4-6 hours if first is normal
12-24 hours high level of suspicion

51
Q

When should troponin levels increase?

A

within 3-12 hours from pain onset
Peak at 24-48 hours
Return to baseline 5-14 days

52
Q

If your patient has ST-segment elevation on ECG and ischemic chest pain, do you wait for troponin results to treat them?

A

No! Still draw the troponin but treat them right away with thrombolytics or coronary angioplasty

53
Q

What labs do you check for heart failure?

A

BNP or N-terminal pro-BNP

54
Q

Should you compare previous BNP or NT-proBNP from prior visits when trying to look for heart failure?

A

No! Different reference ranges and different assays

55
Q

Do all patients with symptomatic HF have high plasma BNP or NT-proBNP?

A

No, not all patients with HF have it and not all asymptomatic patients have low values

56
Q

What can help you guide management of acute HF?

A

Serial BNP

57
Q

Ordering lipid panels for screening purposes is _____ prevention

A

Primary

58
Q

Ordering lipid panels for monitoring purposes is _____ prevention

A

Secondary

59
Q

What is the total cholesterol goal?

A

Less than 200

60
Q

What is the HDL cholesterol goal?

A

Greater than 60

61
Q

What is the LDL cholesterol goal?

A

Less than 100 for those at risk for heart disease, less than 70 for those who have heart disease

62
Q

What is the triglyceride goal?

A

Less than 150

63
Q

What 3 diagnoses do you not want to miss because they are medical emergencies and can all present with chest pain?

A

MI
PE
Aortic dissection

64
Q

Red flags with chest pain

A 
Severe, unrelenting sub-sternal pain
Unstable vitals
Moderate - Severe sSOB
Diaphoresis, anxiety
Patient voices feeling impending doom
65
Q

Optimal BMI?

A

18.5-24.9

66
Q

Where does pain usually radiate to with angina?

A

Left arm and shoulder

67
Q

High-pitched, grade 2/6, blowing decrescendo diastolic murmur, heard best in the 4th ICS with radiation to the apex

A

Aortic regurgitation

Clin Assess CV (3 decks)

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