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POM unit 4 > chest pain > Flashcards

chest pain Flashcards

1
Q

somatic pain character

A

sharp or hot sensation that is well localized

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2
Q

visceral pain character

A

difficult to describe sensations that are poorly localized and oftren sensed remote from the source

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3
Q

specific test

A

positive in disease and few false positives

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4
Q

sensitive test

A

negative in health and few false negatives

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5
Q

five things to always ask when confronted with chest pain

A

nature, aggravating or alleviating factors, radiating pain, tome course, location

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6
Q

other things to always ask about chest pain?

A

fever, cough, dyspnea (exertional or night time), extremity or trunk pain

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7
Q

aortic disease that causes chest pain

A

aneurysms (thoracic, abdominal), dissecting aneurysms, traumatic rupture, intramural hematoma, aortic ulcer

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8
Q

what is the etiology of aortic dissection?

A

HTN, connective tissue disease, pregnancy, congenital cardiac abnormalities, aortic ulcers and crypts.

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9
Q

how does dissection present most commonly?

A

DIVERSE! sharp chest pain radiating to the back (85%).

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10
Q

other presentations of dissection

A

pain in back only, pain that moves, may radiate to the neck and jaw, arms or lumbar area. syncope (10-12%). end-organ ischemia. neurological defects are common

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11
Q

dissection on exam?

A

pulse defects (20%), aortic insufficiency, tamponade, altered mental status, hemiplegia/paraplegia, horner’s syndrome.

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12
Q

is a chest XR abnormal in dissection?

A

yes, commonly 87% but in nonspecific manner.

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13
Q

what does the CXR show on dissection

A

mediastinal widening, bulging aortic contour, pleural effusions, intimal calcium sign

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14
Q

EKG useful in dissection?

A

yes to R/O other causes

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15
Q

what are sensitive and specific tests for dissection

A

CT, angiogram, TEE

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16
Q

pleural diseases that cause chest pain?

A

spontaneous pneumo, pleural effusions, pleurisy

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17
Q

how is the pleura innervated?

A

somatically

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18
Q

what is normal intrapleural pressure?

A

-4 to -12

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19
Q

what does the lung normally do>

A

it recoils away from the chest wall and the intrapleural fluid keeps the lung inflated

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20
Q

what do most pneumo patients have?

A

a bleb. wall tension increases with radius

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21
Q

what does spontaneous pneumothorax imply?

A

primary, nontraumatic event

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22
Q

what does tension pneumo imply?

A

increased intrapleural pressure above the central venous pressure

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23
Q

which pneumo patients are asym?

A

many. but especially COPD patients/

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24
Q

which pneumo patients have a high mortality?

A

COPD 16%

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25
who does spontaneous pneumo afflict most often?
tall, thin, males.
26
what is associated with pneumo
smoking, marfans, alpha-1 antitrypsin deficiency and changes in atmospheric pressure
27
tension pneumo
a defect in the pleural barrier acts as a ball valve that accumulates pressure
28
what happens if the pressure of tension exceeds central venous pressure?
decreased venous return and hypotension
29
how does tension pneumo present?
subcut air, tracheal deviation, shock, EMD.
30
how does pneumo present?
chest pain which is pleuritic, course is often subacute, mild dyspnea, decreased breath sounds unilaterally, tympanic hemithorax, absent tactile fremitis, hamman's crunch
31
how does a pleural effusion present
asymp, chest pain, dyspnea, decreased breath sounds, dullness to percussion, large effusions may show signs of mediastinal shift
32
how much fluid from a pleural effusion is necessary to see before costphrenic angle is blunted on CXR?
500cc, 200cc on lateral film
33
what organisms most likely cause empyema?
staph, strep and gram -
34
when does empyema occur?
after pneumonia, lung infarction, resection, or abdominal infection
35
how do we treat empyema?
drainage and antibiotics
36
pericarditis presents how?
positional pain, always has some myocarditis, with the four stages of ECG progression.
37
what can cause pericarditis?
viral, rheumatological, traumatic, post MI
38
pneumomediastinum presents how?
air comes from the esophagus, trachea, bronchi, neck or abdomen and dissects along vascular or bronchial planes centrally. hammans sign. rarely causes compression and impairment of venous return
39
PE risk factors
trauma, immobilization, cancer, surgery, BCP. well's criteria
40
well's criteria score
>6 high prob. <2 low prob.
41
ischemic heart disease includes what for chest pain?
myocardial infarction, angina pectoris, heart failure.
42
how sensitive is am H&P and EKG? | how about with serum marker
96%, 98%
43
what percent of all infarcts are silent?
25-33%
44
what is the first step in MI?
usually an atheroma ruptures and inflammation and acute clotting occurs. oxygen delivery is disrupted.
45
what happens after the O2 delivery is disrupted to myocardium?
it becomes ischemia and then infarcted. contractility decreases.
46
what is more likely in infarcted areas?
dysrhythmia and disorders of automaticity
47
what can cause nonatheromatous MI?
arteritis, syphilis, amyloidosis, congenital anomalies of the heart, toxins, and emboli
48
what is mandatory on the physical exam
heart, lung ands vascular exams
49
ST elevation is characteristic of what?
injury
50
ST depression is characteristic of what?
reciprocal change, or nonspecific.
51
Q wave means what?
infarction!
52
abnormal myocardium is what?
more positive at the end of depolarization than normal
53
what percentage of AMI have ST elevations?
30-50%. 1-4% have normal EKG
54
how fast must the initial EKG be taken and interpreted?
10 minutes.
55
ST segment elevation without MI?
early depolarization, LVH, pericarditis/myocarditis, hypothermia, LV aneurysms,
56
what percentage of STEMI codes have non-actionable coronary?
23%
57
St depression without ischemia?
hypokalemia, digoxin effect, for pulmonale, LVH. IVCD/paced.
58
what is cor pulmonale?
right ventricular hypertrophy and failure due to pulmonary HTN
59
T wave inversions without ischemia
peds EKGs, IVCD/paced, intracranial pathology, cor, etc
60
markers of MI?
CK/MB, troponin, myoglobin, myosin, inflammatory (only of intellectual interest), BNP in response to atrial stress?
61
how long is the peak and duration of CK/MB?
P: 18-24 hrs duration: 2 days
62
how long is the peak and duration of troponin I ?
P: 18 hrs. duration: 10 days
63
ECG pericarditis
stage 1: widespread ST elevation, 2: ST normalization, with T wave flattening, 3: T waves invert, 4: resolution over several weeks

POM unit 4 (5 decks)

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