Chest Pain Flashcards
What are 5 pulmonary DD in a patient that presents with chest pain?
pneumothorax; hemothorax; Pulmonary embolism; pleuritic CPX; pneumonia
What are 2 psychogenic DD in a patient that presents with chest pain?
anxiety; anxiety attack
What are 4 musculoskeletal DD in a patient that presents with chest pain?
Pulled muscle; costochondritis; herpes zoster; sepsis
What are 6 GI DD in a patient that presents with chest pain?
GI bleed; esophageal rupture; biliary cholangitis; obstructed bowel; GERD
What three cardiac conditions fall under Acute coronary syndrome?
STEMI; NSTEMI: Unstable angina
A patient presenting to the ED with chest pain should have an ECG within _____ of arrival to rule out what as your first differential diagnosis?
10 minutes
Rule out ACS
What are the cardiac DD of a patient presenting with chest pain?
Ask me to define each :)
- Cardiac tamponade: increase in pressure around heart and the body cant get enough blood bc heart can expand and pump (caused by pericardial effusion)
- MI: heart attack; blood vessels that supply blood to heart tissue are blocked & heart muscle dies
- Pericardial effusion: fluid filling pericardial sac
- Stable Angina: heart doesn’t get enough O2; usually brought on by exertion
-Aortic dissection: tear of the inner lining of the aorta
Aortic rupture: tear through all layers of aorta; super deadly
What labs should be drawn in a PT reporting chest pain?
CBC
BNP
BMP
Blood gas
Troponin
Tox/drug screen
D-dimer
A 52y/o male presents to the ED with sudden onset chest pain, nausea, vomiting, SOB. His skin is cool and clammy and he states a 30 year HX of smoking. What is the likely dx and tx of this pT?
myocardial infarction
#1 get cardiac catheterization to revascularize the heart tissue
Administer chewable aspirin, O2
If you are working in a hospital without a cath lab to revascularize a PT with an MI, what can you do in the mean time to help this PT?
give thrombolytics
What is an indication for percutaneous coronary intervention?
in a case of ACS to open the blood vessel
What is a thrombectomy?
the direct removal of a clot via mechanical catheter and US
what is percutaneous coronary intervention?
use of a guided catheter to balloon and open an artery and possibly place a stent
What is thrombolytic therapy?
also called thrombolysis; drug administered via IV or catheter to dissolve a blood clot
What are the indications for administering thrombolytic therapy?
In a case of ACS, ischemic stroke, or any type of clot
(also if you don’t have a cath lab)
What are the contraindications to administering thrombolytic therapy?
Active bleed;
recent brain hemorrhage;
malignant brain cancer;
severe HTN;
recent brain/spinal surgery;
TBI;
severe kidney disease;
aortic dissection
What is the definition of hypertensive urgency?
Acute BP elevation without end organ damage
Systolic BP >160-180 -OR-
Diastolic BP >100-120
What is the definition of hypertensive emergency?
Acutely elevated BP with end organ damage
Systolic BP >180 -OR-
Diastolic BP >120
What is the treatment for hypertensive urgency?
Put on BP meds and send home
What is the treatment for hypertensive emergency?
Admit to hospital and give IV BP meds
A patient presents to the ED with gnawing epigastric pain, epigastric tenderness, and upon exam you feel an ABD aortic pulse and hear midline bruit. What is the DX & TX?
abdominal aortic aneurysm
Send to vascular surgery
A patient presents to the ED with a complaint of acute onset chest pain that feels dull, & achy. They report trouble with their vision and a headache since the onset of the chest pain. The patient appears ill during the exam, has a 25 year smoking hx, and has a BMI of 33. What is the likely DX, what will you see on chest x-ray?
Aortic dissection
widening mediastina
Aortic aneurysms have two types, A & B, how are these types classified and what is the treatment for each of them?
A: tear in ascending aorta: tx by sending to surgery now
B: tear in descending aorta; tx with BP control with beta blocker, Nitroprusside (vasodilator), pain management
A patient presents to the ED with a complaint of chest px that’s worse when lying down and relieved when they sit up. The patients vitals are normal. What is the likely DX, what will you hear with your stethoscope, and what is the tx?
pericarditis
hear friction rub from irritated tissue
NSAIDS for pain - usueally goes away on own
Chest PX DD: Chest pain, weakness, nausea, and fatigue, ill appearing PT with rales?
ACS
Chest PX DD: Pleuritic chest pain, SOB, Tachycardia, clear lungs, unilateral leg swelling?
Pulmonary embolism
Chest px DD: Sudden onset severe ripping pain to back with paresthesia or paralysis, unequal bp, weak pulses?
Aortic dissection
Chest px DD: Sudden onset severe unilateral pleuritic chest pain, Hypotension, unequal breath sounds, tracheal deviation?
tension pneumothorax
Chest px DD: Intense substernal chest pain after vomiting or endoscopic procedure & a crackle sound heard or felt in time w/ heart beat
Esophageal rupture
