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Medical Emergencies Final > Chest Pain > Flashcards

Chest Pain Flashcards

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USMLE® Step 1 flashcards
1
Q

Three common causes of acute chest pain:

A

Angina
Hyperventilation
MI

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2
Q

CAD most commonly occurs between the ages of:

A

50 to 70

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3
Q

Three consequences of nicotine use:

A
  • Increases myocardial demand for oxygen
  • Increases adhesiveness of platelets
  • Lowers the threshold for ventricular fibrillation
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4
Q

Consequence of carbon monoxide on the body:

A

prevents O2 from combining with hemoglobin (oxyhemoglobin) which decreases O2 availability to tissues

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5
Q

______ serum cholesterol levels are associated with _____ incidence of CAD. _______ lipoproteins are ________ and directly related to CAD.

A
  • Increased
  • Increased
  • Low density
  • Atherogenic
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6
Q

What type of lipoproteins show an inverse relationship with CAD?

A

HDLs

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7
Q

_____ and ______ both increase incidence of CAD.

A

Hypertension

Hyperglycemia

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8
Q

Two types of chronic ischemia:

A

Heart failure

Dysrhythmias

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9
Q

Two types of acute ischemia:

A

Angina

TIA

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10
Q

Two types of infarction:

A

MI

CVA

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11
Q

There are four ways to develop atherosclerotic lesions. There can be a multiplication of _________ in the intimal layer in response to pressure changes. An increased ______ of ______ into lesions leading to plaque formation. You can develop a ______ tissue ingrowth. ______ deposition creates a hard lesion to obstruct blood flow.

A
  • smooth muscle cells
  • influx of lipids
  • fibrous tissue ingrowth
  • calcium deposition
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12
Q

Location of atherosclerosis are commonly in _______ segments of medium sized coronary arteries, arteries on the surface of _______, or the most common site is the _______ branch of the ______ coronary artery.

A
  • proximal segments of medium coronary arteries
  • surface of myocardium
  • anterior descending branch of left coronary artery
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13
Q

______ is a sign indicating that they have CAD. This indicates that the myocardium is not receiving enough oxygen, signaling that ________ has developed.

A
  • Angina

- Myocardial ischemia

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14
Q

How long does stable angina last and how is it relieved?

A
  • lasts 1 to 15 minutes

- relieved with rest and/or nitroglycerine

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15
Q

When is variant angina most likely to occur? What is it often associated with? What causes it?

A
  • at rest; often wakes patient up at night
  • associated with dysrhythmias or conduction defects
  • caused by coronary artery spasm
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16
Q

What would be some signs and symptoms of variant angina? What relieves it?

A
  • Syncope, dyspnea, palpitation

- Nitroglycerine

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17
Q

What does unstable angina lie between?

A

stable angina and acute MI

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18
Q

Subsets of angina:
Group I: angina on ________
Group II: angina on _____ with a ______ pattern
Group III: angina at _____ lasting 15+ minutes.

A

Group I: angina on effort of recent origin
Group II: angina on exertion with a changing pattern
Group III: angina at rest lasting 15+ minutes.

19
Q

Should you treat patient with unstable angina?

A

NO! Treat them as though they just had an MI

20
Q

If a patient uses these words, it’s probably NOT anginal:

A 
Shooting
Knife like
Sharp
Stabbing
Fleeting
Tingling
21
Q

If a patient uses these words, it probably IS anginal:

A

Dull, aching, heavy pain
Squeezing, pressing, strangling
Constricting, bursting, burning, weight on chest, “gas”

22
Q

_____ episode characterizes angina. What is it?

A

Levine sign

closed hand/fist to chest

23
Q

Where is pain located for angina? Is it usually localized or generalized?

A
  • middle and substernally
  • generalized
  • may radiated to left shoulder, distally down medial surface of left arm (uncommon areas include right shoulder, left neck, left side of face and mandible, upper epigastrium)
24
Q

If chest pain lasts less than 30 seconds, it is not anginal but _____.

A

non cardiac origin

25
Q

What usually precipitates anginal episodes and how often do they usually occur?

A
  • exertion

- one to two episodes a week

26
Q

Best ways to deal with anginal pain?

A
  • nitroglycerine

- rest

27
Q

Three methods of pain relief that rule out angina would be the ingestion of ______ or ______, leaning _______, or _______ _____ in deep expiration.

A
  • food or antacids
  • leaning forward
  • holding breath in deep expiration (pleurisy)
28
Q

MI can be indicated by ____ and ____ with severe chest pain. Chest pain with palpitations may be _____ secondary to tachydysrhythmia. Chest pain with ________ may be from pulmonary embolus or lung tumor. Chest pain with fever is often associated with _______ or _______.

A
  • nausea and vomiting
  • ischemia
  • hemoptysis
  • pneumonia or pericarditis
29
Q

What ASA risk is an anginal patient typically?

A

III

30
Q

What is the maximal dose of LA for cardiac risk patient?

A

.04mg

31
Q

Managing cardiac risk patient:

A

P: usually upright
ABC:
D: Administer nitroglycerin (dosages next flash card)
Administer O2
Activate EMS
Continue treatment or discharge if adequate recovery

32
Q

dosages for nitroglycerin:
Transmucosally: ____ or _____ metered sprays, no more than ____ within 15 minutes
Sublingually: one tablet every ____ minutes with no more than _____ within 15 minutes

A

Transmucosally: 1__ or __2 metered sprays, no more than 3__ within 15 minutes
Sublingually: one tablet every __5 minutes with no more than _3__ within 15 minutes

33
Q

Side effects of nitro:

A

fullness, pounding in head
flushing
tachycardia
hypotension

34
Q

Nitro works via _________ by ______ venous blood to the heart, ________ cardiac output to lessen cardiac workload.

A
  • peripheral vasodilation
  • decreasing venous blood to the heart
  • lessening
35
Q

Complications of MI:

A

Shock, heart failure, cardiac arrest

36
Q

cause of MI in 90% of all cases:

A

coronary artery disease

37
Q

Four physical signs/symptoms post MI:

A
  • Peripheral cyanosis
  • Coolness of extremities
  • Peripheral edema
  • Orthopnea
38
Q

Stress reduction protocol for MI:

A
  1. suppl. oxygen (3 to 5 L/min through nasal cannula or 5 to 7 L/min through nasal hood)
  2. Nitrous oxide for sedation
  3. pain control
  4. NO elective treatment within first six months
39
Q

Onset of MI have a sudden onset of _______,_______ type pain, can develop at a time of _____ or period of exercise, high percentage occur ________ (time of day), and ______ stress may precipitate.

A
  • severe, anginal type pain
  • at a time of rest
  • early in the morning
  • emotional
40
Q

Is an MI usually described with words like sharp and stabbing or as “feels like heavy rock or elephant on my chest”?

A

heavy rock or elephant

41
Q

What colors do MI patients express?

A

face: ashen gray

nail beds and mucous membranes: cyanotic

42
Q

What does an MI patient’s skin present as?

A

cool, pale and moist

43
Q

What characterization does an MI patient’s heart rate have?

A
  • weak, rapid

- may be bradycardic

44
Q

When are dysrhythmias present in MI patients?

A

PVC’s seen in 93% of patients

Medical Emergencies Final (4 decks)

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