chest pain Flashcards
1
Q
ddx chest pain
A
cocaine: inc. SNS-->inc. HR, coronary vasospasms (Prinz metal angina) MI PE pheochromocytoma amphetamine intoxication GERD asthma COPD musculoskeletal pericarditis rheumatic disease neuropathy CAD coronary vasospasm valvular heart disease CHF myocarditis acute aortic syndrome stress-induced cardiomyopathy (Takatsubus?) esophageal rupture, perf, hypersn esophagitis pulmonary hypertension pneumonia lung cancer sarcoidosis pneumothorax pleuritis pleural effusion HSV (shingles) mallory-Weiss tear: GE junction tear from GERD, etOH, vomiting Boerhaave: if complete tear hyperthyroidism- thyroid storm SCD-->vaso-occlusive ulcer anxiety: panic attacks cardia temponade pericardial effusion costochondritis (chronic cough) a fib w. RVR foreign body mastitis GSW appendicitis cholestasis of pregnancy-->cholecystitis endocarditis PUD
2
Q
“True” chest pain (angina)
A
Usually last 5-20 minutes Located retrosternal, left precordial Commonly referred to lower jaw, left arm Pressure, tightness, squeezing, “elephant sitting on my chest” -Not sharp
3
Q
angina scale
A
slide- 18
4
Q
alt. ddx to ischemia
A
slide 12
life-threatening: aortic dissection PE tension pneumothorax esophageal rupture perforating PUD
5
Q
non-ischemic
A
aortic dissection
myocarditis
pericarditis
6
Q
chest wall
A
cervical disc disease costochondritis fibrositis HSV (post herpatic neuralgia) neuropathic pain rib fx sternoclavicular arthritis
7
Q
pulmonary
A
??
8
Q
psych
A
??
9
Q
GI
A
??
10
Q
percentage of CP
A
musculoskeletal: 36% GI: 19% cardiac: 16% -stable: 10.5% -unstable/MI: 1.5% -other cardiac: 3.8% psych: 8% pulmonary: 5% other: 16%
11
Q
GERD characteristics
A
??
12
Q
esophageal spasm
A
??
13
Q
PUD char.
A
??
14
Q
biliary disease
A
??
15
Q
cervical disc characteristics
A
??
16
Q
musculoskeletal characteristics
A
??
17
Q
hyperventilation
A
??
18
Q
thyroiditis characteristics
A
??
19
Q
associated symptoms (red flags)
A
Shortness of breath Nausea Diaphoresis Palpitations “Impending sense of doom”
20
Q
“silent” MI
A
Elderly
Women (equivalent to men @ 60 yo)
Diabetes
atypical
ear pain?
21
Q
TIMI risk score
A
to come later
-affects triage, tx
risk stratification
22
Q
Initial workup
A
EKG
Cardiac enzymes (can sometimes fool you)
CXR
23
Q
unstable angina tx:
A
MONA morphine oxygen nitro ASA
