chest pain Flashcards
pressure/squeezing/crushing/smothering sensation in substernal chest AT REST or with minimal exertion or episodes of increasing frequency, severity, or duration
+/- radiation to jaw, shoulder, arm, hand (usually left side)
SOB, sweating
HTN, tachycardic
S4 gallop
unstable angina pectoris
treatment of unstable angina
MONA:
Morphine: ↓ circulating catecholamines →↓ myocardial O2 consumption
Oxygen: 2-4 L/min NC
Nitroglycerin: ↓ myocardial damage + bp, ↓ risk future MI, sublingual, in absence of hypotension or sildenafil: q 5 min x 3 doses → IV or transdermal
B blocker: ↓ myocardial damage + bp, ↓ risk future MI, ↓ mortality, ↓infarct size
Aspirin: ↓ risk future MI + death, 325 mg chewed and swallowed (clopidogrel if allergy)
heparin:↓ risk future MI + death, continue for 2 days or until angiography performed
ACEi: ↓ short-term mortality if started within 24 hrs of acute MI, prevent LV remodeling, ↓ recurrent ischemia, continue indefinately
Mg sulfate: if low Mg to prevent TdP
HMG-CoA reductase inhibitor (statins): within few days of onset
if + EKG changes, add:
GP IIb/IIIa inhibitors (if high-risk unstable angina or non-STEMI treated with percutaneous coronary intervention or refractory to prior treatment): ↓ recurrent ischemia, MI, death
evaluation of unstable angina
ED: EKG + CXR first, CBC, electrolytes, BUN, Cr, PT, PTT, INR, glucose, creatine kinase + MB isoenzyme, troponin T (markers repeat q 6-10 hrs x3)
later studies: fasting lipids, LFT, Mg, homocysteine, UDS, UA, myoglobin
EKG changes
ST elevation
ST depression
T wave inversion
Q wave: myocardial necrosis from completed infarction (benefit of thrombolytic tx uncertain)
LBBB: associated with CAD - draw cardiac enzymes, mimics acute and chronic ischemic changes
elevated CK-MB and/or troponin levels +/- EKG changes
MI
normal EKG
doesn’t rule out MI
cardiac muscle death d/t partial or complete occlusion of one or more coronary arteries
MI
angina only with unusually strenuous activity
class I
angina with more prolonged and vigourous acitivity
class II
angina with daily activity
class III
angina at rest
class IV
cause of acute MI
atherosclerotic plaque rupture → coronary artery thrombosis
causes of angina
coronary artery spasm: cocaine-induced
aortic dissection: extending into coronary artery
endocarditis, prosthetic heart valve, myxoma: emobuls into a coronary artery
risk factors for chest pain conditions
DM hyperlipidemia: MI HTN: CAD, aortic dissection tobacco use: CAD, thromboembolism, aortic dissection, pneumothorax, pneumonia family hx premature CAD: MI male gender >40 yo: CAD postmenopausal status LV hypertrophy: MI trauma to chest: pneumothorax, myocardial or pulm contusion, chest wall injury homocystinemia
treatment of CAD
primary and preventative treatment: aspirin: ↓ risk CAD + CVA nitrates: treat angina symptoms B blocker: ↓ first-year mortality statin
