Chapter 11: Chest Pain

Question 1

Most common cause of chest pain

Answer 1

GI causes

Question 2

Precipitated by an imbalance between myocardial oxygen requirements and myocardial oxygen supply

Answer 2

Myocardial Ischemia

Question 3

Causes of increase Myocardial oxygen demand

Answer 3

increases in heart rate, ventricular wall stress, and myocardial contractility

Question 4

Determines myocardial oxygen supply

Answer 4

coronary blood flow

coronary arterial oxygen content

Question 5

Nerves involved in referred cardiac pain

Answer 5

Upper 5 thoracic sympathetic ganglia

Upper 5 distal thoracic roots of the spinal cord

Question 6

cardiac vagal afferent fibers synapse in the _________

Answer 6

nucleus tractus solitarius of the medulla

Question 7

Tract/Route involved in anginal experience perceived in neck and jaw

Answer 7

Upper cervical spinothalamic tract

Question 8

pain of pleural pericarditis is often referred to the____

Answer 8

shoulder and neck

Question 9

Involvement of the____________ can lead to pain in the upper abdomen.

Answer 9

pleural surface of the lateral diaphragm

Question 10

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.

Answer 10

Takotsubo cardiomyopathy

Question 11

Takotsubo cardiomyopathy has a predeliction to (2)

Answer 11

Women >50 yo

Question 12

a tear in the aortic intima, resulting in separation of the media and creation of a separate “false” lumen

Answer 12

Aortic dissection

Question 13

ulceration of an aortic atheromatous plaque that extends through the intima and and into the aortic media

Answer 13

Penetrating ulcer

Question 14

aortic wall hematoma with no demonstrable intimal flap, no radiologically apparent intimal tear, and no false lumen

Answer 14

Intamural hematoma

Question 15

Area of aortic dissectionthat presents with cause pain in the midline of the anterior chest

Answer 15

Ascending aorta

Question 16

Area of aortic dissectionthat presents with cause pain in the bakc

Answer 16

Descending aorta

Question 17

Type of aortic dissection at high risk for Major complications

Answer 17

Type A (Stanford)

Question 18

3 common complications of aortic dissection

Answer 18

(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

Question 19

conditions associated with deterioration of the elastic or muscular components of the aortic media

Answer 19

pregnancy
bicuspid aortic disease
inherited connective tissue diseases ( eg Marfan and Ehlers-Danlos syndromes)

Question 20

Chest discomfort associated with pulmonary embolism (pleuritic) may result from

Answer 20

(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.

Question 21

chest discomfort associated with pulmonary embolism (pleuritic) may result fromchemia related to acute pulmonary hypertension.

Answer 21

(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

Question 22

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)

Answer 22

syncope
hypotension
signs of right heart failure

Question 23

Incidence of Primary Spontaneous Pneumothorax

Answer 23

7 in 100,000 in men

<2 in 100,000 in women

Question 24

Risk factors for primary spontaneous pneumothorax

Answer 24

male sex
smoking
family history
Marfan syndrome

Question 25

medical emergency caused by trapped intrathoracic air that precipitates hemodynamic collapse

Answer 25

Tension pneumothorax

Question 26

knifelike pain that is worsened by inspiration or coughing

Answer 26

Pleurisy

Question 27

Chest pain caused by tenderness of the costochondral junctions

Answer 27

Tietze’s syndrome (Costochondritis)

Question 28

patients experience relief from angina as they continue at the same or even a greater level of exertion

Answer 28

Warm up angina

Question 29

Radiation to the_____ is characteristic of pericardial pain and does not usually occur with angina.

Answer 29

trapezius ridge

Question 30

In the setting of _____s, redistribution of blood flow to the splanchnic vasculature after eating can trigger postprandialangina

Answer 30

severe coronary atherosclerosis

Question 31

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

Answer 31

> 10 minutes

Question 32

massaging or clutching their chests may describe their pain with a clenched fist held against the sternum

Answer 32

Levine’s sign

Question 33

Indicator of High Risk Disease

Answer 33

Pulmonary Edema

Question 34

_________ may reflect underlying chronic athero- sclerosis

Answer 34

Vascular pulse deficits

Question 35

______ is the preferred biomarker for the diagnosis of MI and should be measured in all patients with suspected ACS at presentation and repeated in ________

Answer 35

Cardiac troponin

3-6 hours

Question 36

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.

Answer 36

Bezold-Jarisch reflex

Question 37

__________is an important manifestation of submassive pulmonary embolism

Answer 37

Sinus tachycardia

Question 38

In Pulmonary embolism/Infarction, a wedge-shaped infiltrate that abuts the pleura

Answer 38

Hampton’s hump

Question 39

In chest xray, an abrupt tapering of a vessel caused by pulmonary embolism

Answer 39

Westermark’s sign