Cardiac Symptoms Flashcards

1
Q

what is the first step in cardiac history taking?

A

describe the following:

Location, quality, severity, timing, setting in which it occurs, remitting or exacerbating factors and associated symptoms to the pain

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2
Q

identify the symptomatic description with the disease

  1. Tearing” or “ripping”; may travel from anterior chest to mid-back
  2. Crushing, sharp, pleuritic; relieved by sitting forward
  3. Intense substernal and epigastrIc hematemesis
  4. Very sharp, pleuritic
  5. Squeezing; may radiate to arm(s), neck, back
A
  1. Aortic dissection
  2. Acute pericarditis
  3. Rupture of esophagus
  4. Acute Pneumothorax
  5. Acute MI
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3
Q

what are the 2 types of angina pectoris?

A
  1. Stable
  2. Prinzmetals
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4
Q

into what categories can we classify acute coronary syndrome?

A
  1. STEMI
  2. Non STEMI
  3. Unstable angina
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5
Q

what are the ischemic heart diseases?

A

Angina pectoris and Acute coronary syndrome

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6
Q

what are the Non ischemic heart diseases?

A
  1. Pericarditis
  2. Aortic dissection
  3. Arrhythmias
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7
Q

what are the Non Cardiac causes for chest pain?

A
  1. Respiratory: Pleurisy, Pneumothorax, Pulmonary embolism
  2. Gastrointenstinal: GERD, Peptic ulcer, Gall stones
  3. chest wall: costochondritis ,Herpes zoster
  4. psychogenic chest pain: Anxiety, panic attack, Hypochondria.
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8
Q

what is Acute Pericarditis?

when will the patient feel relief?

what exacerbates the symptoms?

what is the Classic sign?

what 2 procedures can be ordered to confirm?

what will you detect in the procedures?

A
  • inflammation of adjacent parietal pleural leadign to Sub-sternal pain with radiation to the trapezius ridge
  • shallow breathing and by sitting up and leaning forward.
  • lying down and inspiration
  • friction rib heard over lower left sternal border
  • echocardiogram (diffuse pericardial effusion) and ECG (ST elevation and PR depression)
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9
Q

what is this showing?

A

ST elevation

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10
Q

while doing an echocardiogram on suspected acute pericarditis, what leads will show ST elevation?

A

all except aVR and V1

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11
Q

what is aortic dissection?

what 2 conditions are associated with it?

what clinical finding can be detected?

how do you confirm aortic dissection?

A
  • Sudden, severe “tearing” pain, radiating to the abdomen, neck, or back, depending on where the dissection is going
  • Marfans and hypertension
  • weak asymmetric pulses, wide mediastinum for chest x-ray, intimal flip is visualized in MRI and CT
  • aortic angiogram
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12
Q

what are arrhytmias?

the heart will beat how?

what decides if it is harmful or harmless?

A
  • The abnormal rhythms or an irregular heartbeat.
  • Heart may beat too quickly, too slowly or erratically.
  • whether the atria or ventricle is affected and how well the heart is able to continue pumping blood.
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13
Q

what are the 5 Most Common Arrhythmias?

A
  1. Tachycardia
  2. Bradycardia
  3. Atrial fibrillation (A-fib)
  4. Ventricular Fibrillation
  5. Palpitations
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14
Q

what is Angina Pectoris: Stable angina?

what makes it worse?

what makes the pain go away?

why does it happen?

do you see necrosis?

A
  • Squeezing, crushing, strangling, constricting pain in center of chest, radiate to left shoulder, arm, jaw
  • exercise
  • rest or after sublingual nitroglycerine
  • Subendocardial ischemia due to decreased coronary artery blood flow
  • no
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15
Q

***Why stress precipitates the pain?????

A

Sub endocardium gets the least amount of oxygen from coronary arteries. Coronary arteries fill in diastole and increasing HR decreases time for filling of coronary arteries

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16
Q

how do you diagnose stable angina?

how do you confirm the diagnosis?

A
  • Stress test
    • look for ST segment depression that reverses after disappearance of ischemia
  • No elevation in cardiac biomarkers
  • Confirmed by angiography
17
Q

what is the treatment for stable angina?

what can be used for prevention of stable angina?

A
  • Nitroglycerin S/L is the DOC
  • long acting nitrates
  • Betablockers,
  • Ranolazine (decreases late sodium current and intracellular calcium overload )
  • Aspirin
18
Q

what is another name for Prinzmetal’s angina?

what causes it?

when is it seen?

what may be used to relieve the pain?

what makes the pain come back?

A
  • variant angina or non-classical or vasospastic angina
  • coronary vasospasm NOT OBSTRUCTION!!
  • angina at rest, usually in the morning (it may awaken ppl from sleep)
  • nitrates
  • smoking or cocaine use
19
Q

how do you diagnose variant angina?

what is the treatment for variant angina?

what drug is contraindicated?

A
  • ECG will show transient ST elevation
  • No elevation in cardiac biomarkers
  • Angiography demonstrates not significant coronary obstruction but “coronary spasm”
  • nitrates and CCB
  • beta blockers
20
Q

what is refered to Acute coronary syndromes (ACSs)?

acute coronary syndromes can be Classified based on ECG as what?

which is the worst?

A
  • comprise the spectrum from unstable angina to severe acute MI
  • “ST elevated ” or “Non ST elevated”
  • ST elevated: ST Elevated MI (STEMI) is most severe form, needs immediate reperfusion.
21
Q

in acute coronary syndromes, if there is no ST elevation, what 2 things could it be?

What is the main difference between NSTEMI and unstable angina?

In which (NSTEMI or unstable angina) will you detect raised cardiac enzymes?

A

Unstable angina or NSTEMI

that in NSTEMI the severity of ischemia is sufficient to cause cardiac enzyme elevation.

raised in NSTEMI and not in unstable angina

22
Q

What happens in STEMI?

what may lead to STEMI?

what is used to treat it?

A
  • there is a transmural infarction of the myocardium - which just means that the entire thickness of the myocardium has undergone necrosis - resulting in ST elevation.
  • Usually due to a complete block of a coronary artery (occlusive thrombus).
  • thrombolytics like Streptokinase to lyse the thrombus or tPA
23
Q

what causes unstable angina and NSTEMI?

what can be absent and confirm it?

A
  • partial dynamic block to coronary arteries (non-occlusive thrombus).
  • no ST elevation or Q waves on ECG, as transmural infarction is not seen.
24
Q

answer the table

A
25
Q

what is STEMI?

how many MI are silent?

what is the most common anatomical point that gets occluded causing MI?

A
  • Chest pain similar to angina pectoris, but more intense and persistent, not fully relieved by rest or nitoglycerine, often accompanied by nausea, vomiting, sweating.
  • 25%
  • coronary artery occluded by thrombus at site of atherosclerotic plaque
26
Q

In STEMI, what do you look for in the Physical exam?

A
  • S3/S4 (Systolic or diastolic dysfunction)\
  • Transient murmur of MR due to papillary muscle dysfunction.
  • Pulmonary edema seen in severe MI.
  • Increased or reduced BP and heart rate
  • JVP, kussumal sign suggests Right Ventricular infarction
  • Pericardial friction rub
27
Q

what labs can help detect a MI after some time?

what labs can help detect an MI that has happened early?

A

troponin 1

CK-MB

28
Q

how long does troponin T and 1 lasts?

how long does CK-MB lasts?

A

7 days

24 hours

29
Q

what is the progression seen in an MI in an ECG?

A
  • peaked (“hyperacute”) T waves, to ST-segment elevation, to Q wave development, to T wave inversion
30
Q

what can we find in an ecg in STEMI?

What is a good indicator of the extent of acute infarction and risk of subsequent adverse events?

A

Left bundle branch block,

Sum of the total amount of ST-segment deviation

31
Q

what leads in an ecg will you look for if you have the following?

  1. anterior MI?
  2. Inferior MI?
  3. Lateral MI?
  4. Septal MI?
A
  1. V3 and V4
  2. Lead 2, 3, and aVF
  3. lead 1, aVL, V5 and V6
  4. V1 and V2
32
Q

what aretery is involved if the MI happened in Anterior wall of LV and 2/3 of septum?

what artery is involved if MI is happened posterior and inferior wall of LV, entire RV,1/3 of septum?

what artery is involved if the MI happened in the lateral wall?

A

Left Anterior Descending

RCA

Left circumflex

33
Q
A