Chest pain Flashcards
Inferior MI leads + artery, Lateral MI leads + artery
Inferior MI leads + artery:
II, III, aVF
Right coronary artery
Lateral MI leads + artery:
I, aVL, V5, V6
Left Circumflex Artery
CI to thrombolysis in MI
Active Bleeding
Aortic Dissection
Ischemic Stroke (last 3 months)
Closed Head or Facial Trauma (last 3 months)
Past Intracranial Hemorrhages
Structural Cerebral Vascular Lesions
Malignant Intracranial Neoplasms
Causes of pericarditis
Idiopathic
Infectious (viral, bacterial)
Inflammation (RA, SLE, scleroderma)
Metabolic (renal failure, hypothyroidism, hypercholesterolemia)
CV (MI, post infarction (Dressler’s), aortic dissection)
Misc (neoplasm, drugs, radiation, trauma)
Signs + sx of pericarditis
Sudden onset palpitations, retrosternal pain, pleuritic
Low grade fever, night sweats, wt loss
SOB, tachypnea, non-productive cough
Signs:
Ewart’s sign (dullness + bronchial breath sounds between tips of scapula and spine)
Pericardial friction rub
Ix + results for pericarditis
ECG: PR depression, ST elevation
CXR: normal to water bottle shape heart
Echo: effusion
Labs: CBC, INR, lutes, urea, Cr, ESR, CRP, trop, LDH, AST
Consider CT/ MRI
Rx for pericarditis
ASA 650mg Q4H or or ibuprofen 400mg Q6H x 2 weeks
PPI
Corticosteroids or colchicine for recurrent/ refractory
Signs of tamponade
Hypotension
Tachycardia
Elevated JVP
Pulsus paradoxicus
Causes of CP
CVS: pericarditis, dissection, valve disease, tamponade, HF, ACS
Resp: PE, PNA, pneumothorax, malignancy, pleuritis
GI: GERD, esophageal spasm, hiatal hernia, PUD, biliary colic
MSK: costochondritis, HSV infection (shingles), rib fracture, fibromyalgia
Psych: anxiety. panic, delusion, somatoform
Sx of esophageal spasm
Globus
Dysphagia
GERD
Ix for esophageal spasm
Barium swallow - tertiary waves
Esophageal manometry
Rx for esophageal spasm
Diltiazem
Imipramine
Nitrates
MSK causes of CP
costochondritis, HSV infection (shingles), rib fracture, fibromyalgiA
Tool to work out disposition in MI
HEART score
6-8 wks post MI, recurrent CP DDx + Ix to order
ACS, Dressler’s syndrome, anxiety, PNA, PE. Ix = CRP, echo, CXR
Rx for Dressler’s syndrome
ASA, NSAIDs