Chapter 11: Chest Pain Flashcards
Most common cause of chest pain
GI causes
Precipitated by an imbalance between myocardial oxygen requirements and myocardial oxygen supply
Myocardial Ischemia
Causes of increase Myocardial oxygen demand
increases in heart rate, ventricular wall stress, and myocardial contractility
Determines myocardial oxygen supply
coronary blood flow
coronary arterial oxygen content
Nerves involved in referred cardiac pain
Upper 5 thoracic sympathetic ganglia
Upper 5 distal thoracic roots of the spinal cord
cardiac vagal afferent fibers synapse in the _________
nucleus tractus solitarius of the medulla
Tract/Route involved in anginal experience perceived in neck and jaw
Upper cervical spinothalamic tract
pain of pleural pericarditis is often referred to the____
shoulder and neck
Involvement of the____________ can lead to pain in the upper abdomen.
pleural surface of the lateral diaphragm
triggered by an emotionally or physically stressful event and may mimic acute MI because of its commonly associated ECG abnor- malities, including ST-segment elevation, and elevated biomarkers of myocardial injury.
Takotsubo cardiomyopathy
Takotsubo cardiomyopathy has a predeliction to (2)
Women >50 yo
a tear in the aortic intima, resulting in separation of the media and creation of a separate “false” lumen
Aortic dissection
ulceration of an aortic atheromatous plaque that extends through the intima and and into the aortic media
Penetrating ulcer
aortic wall hematoma with no demonstrable intimal flap, no radiologically apparent intimal tear, and no false lumen
Intamural hematoma
Area of aortic dissectionthat presents with cause pain in the midline of the anterior chest
Ascending aorta
Area of aortic dissectionthat presents with cause pain in the bakc
Descending aorta
Type of aortic dissection at high risk for Major complications
Type A (Stanford)
3 common complications of aortic dissection
(1) compromise of the aortic ostia of the coronary arteries, resulting in M1
(2) disruption of the aortic valve, causing acute aortic insufficiency
(3) rupture of the hematoma into the pericardial space, leading to pericardial tamponade
conditions associated with deterioration of the elastic or muscular components of the aortic media
pregnancy
bicuspid aortic disease
inherited connective tissue diseases ( eg Marfan and Ehlers-Danlos syndromes)
Chest discomfort associated with pulmonary embolism (pleuritic) may result from
(1) involvement of the pleural surface of the lung adjacent to a resultant pulmonary infarction
(2) distention of the pulmonary artery
(3) possibly, right ventricular wall stress and/or subendocardial ischemia related to acute pulmonary hypertension.
chest discomfort associated with pulmonary embolism (pleuritic) may result fromchemia related to acute pulmonary hypertension.
(1) involvement of the pleural surface of the lung adjacent to a resultant pulmonary infarction
(2) distention of the pulmonary artery
(3) right ventricular wall stress and/or subendocardial ischemia related to acute pulmonary hypertension
Massive pulmonary emboli may cause severe substernal pain that may mimic an MI. Massive or submassive pulmonary embolism may also be associated with what symptoms (3)
syncope
hypotension
signs of right heart failure
Incidence of Primary Spontaneous Pneumothorax
7 in 100,000 in men
<2 in 100,000 in women
Risk factors for primary spontaneous pneumothorax
male sex
smoking
family history
Marfan syndrome
medical emergency caused by trapped intrathoracic air that precipitates hemodynamic collapse
Tension pneumothorax
knifelike pain that is worsened by inspiration or coughing
Pleurisy
Chest pain caused by tenderness of the costochondral junctions
Tietze’s syndrome (Costochondritis)
patients experience relief from angina as they continue at the same or even a greater level of exertion
Warm up angina
Radiation to the_____ is characteristic of pericardial pain and does not usually occur with angina.
trapezius ridge
In the setting of _____s, redistribution of blood flow to the splanchnic vasculature after eating can trigger postprandialangina
severe coronary atherosclerosis
A delay of _______ before relief is obtained after nitroglycerin suggests that the symptoms either are not caused by ischemia or are caused by severe ischemia, such as during acute MI
> 10 minutes
massaging or clutching their chests may describe their pain with a clenched fist held against the sternum
Levine’s sign
Indicator of High Risk Disease
Pulmonary Edema
_________ may reflect underlying chronic athero- sclerosis
Vascular pulse deficits
______ is the preferred biomarker for the diagnosis of MI and should be measured in all patients with suspected ACS at presentation and repeated in ________
Cardiac troponin
3-6 hours
Activation of receptors in the atria, great veins, and left ventricle causing increased parasympathetic tone and decreased sympathetic activity leading to a combination of hypotension and bradycardia with a sudden increase in coronary flow.
Bezold-Jarisch reflex
__________is an important manifestation of submassive pulmonary embolism
Sinus tachycardia
In Pulmonary embolism/Infarction, a wedge-shaped infiltrate that abuts the pleura
Hampton’s hump
In chest xray, an abrupt tapering of a vessel caused by pulmonary embolism
Westermark’s sign
