Cardio CIS Handout Flashcards
Cardiovascular etiologies of chest pain
Acute coronary syndrome (ACS) — unstable angina, NSTEMI, STEMI, pericarditis, pericardial tamponade, aortic dissection, valvular heart disease
Pulmonary etiologies of chest pain
PE Pneumothorax (PTX) Pleurisy Asthma exacerbation COPD exacerbation Respiratory infection
Gastrointestinal etiologies of chest pain
GERD Esophageal spasm Esophagitis Esophageal rupture (Boerhaave) Hiatal hernia Pancreatitis
MSK etiologies of chest pain
Costochondritis
Rib fracture/contusion
Pectoralis spasm
Endocrine etiology of chest pain
Hyperthyroidism
Psychiatric and other causes of chest pain
Severe anxiety, panic attacks, cocaine induced vasospasm
Other: sickle cell, rheumatic diseases, sarcoidosis, herpes zoster
Possible PE findings in pt with acute coronary syndrome
Hypotension/hypertension
Diaphoresis with cool/clammy skin
JVD
3rd or 4th heart sound
Rales on pulmonary auscultation
Most common presentation of acute coronary syndrome
Pressure-type retrosternal chest pain that typically occurs at rest or with minimal exertion lasting >10mins
Can radiate to either or both arms, neck, or jaw
Unexplained new-onset or increased exertional dyspnea is the most common angina equivalent
What are atypical presentations of acute coronary syndrome? What patient populations tend to present this way?
Atypical symptoms may include epigastric pain, indigestion, stabbing or pleuritic pain, and increasing dyspnea in the absence of chest pain
Usually older patients, women, diabetics, impaired renal function, and dementia present this way
Negative risk factor (i.e., protective) for cardiovascular disease
HDL > 60 mg/dL
Risk factors for cardiovascular disease
Increasing age
M>F
Smoking/second-hand smoke
Sedentary lifestyle (need moderate exercise 3x/week)
Obesity (BMI >30 or waist girth >102cm/40in in men and >88cm/30in in women)
HTN (>140/90)
Dyslipidemia (LDL >130 or HDL <40 or TC >200)
Pre-diabetes (IFG >100 or OGTT 140-199)
Psychosocial stress
Family hx
Describe stable angina
Intermittent chest pain that can be brought on by exertion or duress
Improves with rest and/or nitro
Episodes tend to be similar in nature and last 2-5 mins
Describe unstable angina
Chest pain that can occur at rest, pain tends to escalate over time, episodes last ~10 mins
Does NOT respond to rest or nitro
High risk of adverse event — NSTEMI/STEMI
ECG findings and cardiac enzymes with unstable angina
Nonspecific; may have inverted T wave
ECG changes are typically transient
Normal cardiac enzymes
What is an NSTEMI and how does it present on ECG and cardiac enzymes?
Complete occlusion of minor coronary artery or partial occlusion of major coronary artery that causes ischemia, tissue damage, and possible myocyte damage/necrosis
EKG findings vary - normal or may have ST depression, T wave inversion
Elevation of cardiac enzymes
What is an STEMI and how does it present on ECG and cardiac enzymes?
Complete vascular occlusion of major coronary artery leading to ischemia and myocardial damage/necrosis
ECG: ST elevations affiliated with area of heart where blood flow is affected; may also have new LBBB
Elevated cardiac enzymes, severe symptoms
Immediate medication treatment for ACS
MONA-B
Morphine O2 Nitro ASA Beta blocker
Labs and tests to order immediately on presentation with ACS
CBC - check for anemia
CMP - check for electrolyte imbalances; liver or kidney dysfunction
Cardiac markers - Troponin (I or T) immediately, then repeat q6h x3
CXR - evaluate for potential causes of chest pain
EKG - immediately, then repeat q8h x3
[consider doing lipid panel later to check for HLD; also consider urine drug screen]
What 3 scenarios in pt presenting with ACS warrant STAT cath lab transfer?
Uncontrollable chest pain
New LBBB
STEMI
Use of _____________ within 24 hours of presentation is a contraindication to use of NTG
Phosphodiesterase inhibitors (e.g., Sildenafil - Viagra)
[secondary to hypotensive effects d/t systemic vasodilation — can result in severe hypotension or even death]
Viscerosomatics for heart and lungs
Heart:
Sympathetic — T1-5
Parasymp — Vagus (CN X)
Lungs:
Sympathetic — T2-7
Parasymp — Vagus (CN X)
Pain tolerance may be lowered in pts with ACS due to hyperactivity of sympathetic nervous system. Various OMT techniques may be used to address this, but it is important to be careful in pts with _________
Arrhythmias
Anterior chapmans reflexes for myocardium, bronchus, upper lung, lower lung
Myocardium: 2nd ICS @ SB
Bronchus: 2nd ICS @ SB
Upper lung: 3rd ICS @ SB
Lower lung: 4th ICS @ SB
Posterior chapmans reflexes for myocardium, bronchus, upper lung, lower lung
Myocardium: intertransverse spaces between T2-3
Bronchus: lateral to T2 spinous process
Upper lung: intertransverse space T2/T3 AND intertransverse space T3/4
Lower lung: intertransverse space T4/T5
