Chest pain

Question 1

What are the angina equivalent symptoms (7)

Answer 1

1 dyspnea at rest or exertion; 
2 shoulder, arm, or jaw discomfort; 
3 nausea;
4 light-headedness;
5 generalized weakness;
6 acute changes in mental status; 
7 diaphoresis

Question 2

Patients more prone to atypical symptoms of ACS (4)

Answer 2

1 diabetes,
2 advanced age,
3 psychiatric disease,
4 altered mental status

Question 3

Other life-threatening conditions that present with chest pain (7)

Answer 3

1 aortic dissection,
2 pulmonary embolism,
3 pneumothorax,
4 pericarditis,
5 pericardial tamponade,
6 pneumonia, 
7 esophageal rupture

Question 4

Risk factors for aortic dissection include (8)

Answer 4

1 atherosclerosis,
2 uncontrolled hypertension,
3 coarctation of the aorta,
4 bicuspid aortic valves,
5 aortic stenosis,
6 Marfan syndrome,
7 Ehlers-Danlos syndrome,
8 pregnancy

Question 5

7 signs and symptoms with high LR for aortic dissection

Answer 5

Symptoms	Increased Disease Probability (Positive L R)
1 Tearing/Ripping Pain	10.8× (5.2-22.0)
2Migrating pain	7.6× (3.6-16.0)
3 Sudden Chest Pain	2.6× (2.0-3.5)
4 Hx of Hypertension	1.5× (0.8-3.0)
5 Focal Neurologic Deficit	33.0× (2.0-549.0)
6 Diastolic Heart Murmur	4.9× (0.6-40.0)
7 Pulse Deficit	2.7× (0.7-9.8)

Question 6

Sharp chest pain after an episode of forceful vomiting is in favour of …

Answer 6

Esophageal rupture (Boerhaave syndrome)

Question 7

4 ECG finding that increase the +LR of AMI

Answer 7

1 Any ST-segment elevation
2 New conduction defect
3 New ST-segment elevation (>1 mm)
4 New Q wave

Question 8

Conditions with elevated trop in the absence if coronary artery disease (7)

Answer 8

1 Cardiac contusion
2 Cardioinvasive procedures (surgery, ablation, pacing, stenting)
3 Acute or chronic congestive heart failure
4 Aortic dissection
5 Aortic valve disease
6 Hypertrophic cardiomyopathy
7 Arrhythmias (tachy- or brady-)
8 Apical ballooning syndrome
9 Rhabdomyolysis with cardiac injury
10 Severe pulmonary hypertension, including pulmonary embolism
11 Acute neurologic disease (e.g., stroke, subarachnoid hemorrhage)
12 Myocardial infiltrative diseases (amyloid, sarcoid, hemochromatosis, scleroderma)
13 Inflammatory cardiac diseases (myocarditis, endocarditis, pericarditis)
14 Drug toxicity
15 Respiratory failure
16 Sepsis
17 Burns
18 Extreme exertion (e.g., endurance athletes)

Question 9

Among patients with end-stage renal disease, a greater proportion will have an elevated troponin … (15% to 50%) compared with troponin … (

Answer 9

Trop T

Trop I

Question 10

CK levels become elevated within… to… hours after coronary artery occlusion, peak between … and … hours, and return to normal between … and …days

Answer 10

4 to 8
12 and 24
3 and 4

Question 11

Likelihood Ratios of Chest Pain Radiation Patterns for Myocardial Infarction

Answer 11

Pain radiation LR+ (95% CI)
Both arms with pain 9.7 (4.6-20)
Right arm pain 7.3 (3.9-14)
Left arm pain 2.2 (1.6-301)
Right shoulder pain 2.2 (1.4-3.4)