Chest Pain Flashcards
Common causes of nonemergent chest pain
in order from highest prevalence to least
- Musculoskeletal (costochondritis)
- GI, other/unknown
- Cardiac (stable angina, other, then unstable/MI)
- psychiatric
- pulmonary
S/S of GERD (non cardiac cause of chest pain)
visceral, substernal, worse w/ recumbency, no radiation, relief w/ food and antacids
-pain lasts 5 mins- 1 hr
S/S of Esophageal spasm (non cardiac cause of chest pain)
- visceral, spontaneous, substernal, associated w/ cold liquids, relief w/ nitroglycerine
- pain lasts 5 mins- 1 hr
S/S of Peptic ulcer (non cardiac cause of chest pain)
- visceral, burning, epigastric, relief w/ food and antacids, normal EKG
- pain lasts hrs
S/S of Biliary disease (non cardiac cause of chest pain)
- visceral, epigastric, interscapular colic, occurs after meals
- pain lasts hours
S/S of Cervical disc (non cardiac cause of chest pain)
-superficial, positional, arm and neck
S/S of Musculoskeletal (non cardiac cause of chest pain)
-superficial, positional, worse w/ movement, local tenderness
S/S of Hyperventilation (non cardiac cause of chest pain)
- visceral, substernal, tachypneic, anxious
- pain lasts 2-3 mins
S/S of Thyroiditis (non cardiac cause of chest pain)
- aggravated by swallowing, neck, throat tenderness
- persistent
TRUE chest pain (angina)
- 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
Definite angina
substernal discomfort precipitated by exertion, w a typical radiation to the shoulder, jaw or inner aspect of arm, relieved by rest or nitro in less than 10 mins
Probable angina
Has most of the features of definite angina but my not be entirely typical in some aspects
“Probably not” angina
atypical overall pattern of chest pain that does not fin in the description of definite angina
“Definitely not” angina
chest pain is unrelated to activity, appears to be clearly of non-cardiac origin and is not relieved by nitro
Associated symptoms with chest pain
Shortness of breath Nausea Diaphoresis Palpitations “Impending sense of doom”
“Silent” MIs are most commonly seen in
elderly, women, diabetics
TIMI risk score
-categorizes a patient’s risk of death and ischemic events and provides a basis for therapeutic decision making
Calculating TIMI risk score
1 point for each:
- Age ≥ 65
- Aspirin use in the last 7 days (patient experiences chest pain despite ASA use in past 7 days)
- At least 2 angina episodes within the last 24hrs
- ST changes of at least 0.5mm in contiguous leads
- Elevated serum cardiac biomarkers
- Known Coronary Artery Disease (CAD) (coronary stenosis ≥ 50%)
- At least 3 risk factors for CAD:
1. Hypertension -> 140/90 or on anti-hypertensives
2. Current cigarette smoker
3. Low HDL cholesterol (
TIMI scoring
Score of 0-1 = 4.7% risk Score of 2 = 8.3% risk Score of 3 = 13.2% risk Score of 4 = 19.9% risk Score of 5 = 26.2% risk Score of 6-7 = at least 40.9% risk
Initial work up for chest pain
EKG
Cardiac enzymes
CXR
OMM
rib raising
