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
