Chest Pain Flashcards
Acute coronary syndrome
Leading cause of death in the US
Represents a spectrum of conditions ranging from chronic stable angina to AMI
Angina Pectoris
Discomfort induced by exercise and relieved with rest and/or nitroglycerin
New onset angina
Angina that develops within a 2 month time frame
Unstable angina
Angina that occurs with more frequent occurrence of anginal episodes, longer lived episodes or more easily provoked angina
Atypical or Prinzmental angina
angina that occurs at rest
Stable angina
Anginal symptomatology that occurs with the same degree of exertion and resolves with the same degree of rest and/or same dosage strength and frequency of nitroglycerin
High risk characteristics for ACS
- pressure or squeezing quality
- pain similar to prior AMI or angina
- radiation to neck, shoulders or left arm
- associated dyspnea
- use of drugs such as amphetamines, cocaine, ecstasy
Lower risk characteristics for ACS
- pleuritic quality of pain: sharp/stabbing
- pain reproducible with palpation or movement
- pain is of very short duration (seconds)
- pain is of very long duartion (pain for several hours or even days)
Acute Coronary Syndrome Evaluation
Evaluate hemodynamic status
Vitals
Skin color and/or diaphoresis
Bradycardia w/ chest pain should raise concern of an inferior MI
ACS Risk factors
Previous cardiovascular dz, older age, tobacco, high levels of LDL and cholesterol, low levels of HDL, DM, HTN, lac of physical activity, obesity, chronic kidney dz, excessive alcohol consumption, illicit drug use
Aortic dissection findings
Unequal pulses
Pain radiating to back
Dvlpmnt of new murmur of aortic insufficiency
What three conditions does ACS usually occur as a consequence from?
STEMI (ST elevation myocardial infarction)
Non-STEMI
Unstable angina
Pathophysiology behind ACS
Endothelial injury and plaque formation
Immediate tx for suspected acute MI
Oxygen
Aspirin
Sublingual nitroglycerin
NSTEMI Tx
May be managed with medication
Coronary angioplasty may be required if pt’s risk warrants it
Pt’s with multiple arterial blockages may benefit from coronary artery bypass surgery
Troponin
A relatively late cardiac marker of ACS
Complex of 3 regulatory proteins (Troponin C, Troponin I and Troponin T)
How are most cases of STEMI treated?
Reperfusion therapy such as percutaneous intervention (PCI) or Thrombolysis
Aortic aneurysm
General term for any swelling of aorta to greater than 1.5x normal, usu representing an underlying weakness in the wall of the aorta at that location
Main concern for aortic aneurysm
Risk of rupture –> severe pain, internal hemorrhage and death if not treated immediately
Cardiac tamponade
caused by the buildup of fluid inside the pericardium
Beck’s Triad
3 signs of classical cardiac tamponade:
- BP goes down
- JVD occurs
- Muffled heart sounds
Signs of cardiac tamponade
Beck’s triad
Pulsus paradoxus: drop of at least 10 mmHg in arterial BP on inspiration
Ssxs of shock
In which pts should pulmonary embolism be considered in?
Anyone who presents with chest pain that is usually but not necessarily pleuritic in nature or dyspnea that is not fully explained by the clinical evaluation, chest radiograph or ECG
Diagnostic tests for PE
computed tomography pulmonary angiography (CT-PA)
ventilation-perfusion (V/Q) scanning
D-dimer testing
Conventional pulmonary angiography
Pneumothorax
Abnormal collection of air or gas in pleural space that separates the lung from the chest wall and which may interfere with normal breathing
Primary pneumothorax
Occurs without an apparent cause and in the absence of significant lung dz
Secondary pneumothorax
Occurs in the presence of existing lung dz
Tension pneumothorax
Medical emergency.
Considered to be present when a pneumothorax leads to significant impairment of respiration and/or blood circulation
Most common findings in people with a tension pneumothorax
Chest pain and respiratory distress
Often increased HR and RR
Displacement of trachea away from affected side
Queiter breath sounds on one side of the chest
Low oxygen levels
Decreased BP
Pneumonia
Suspect when there is chest pain accompanied by additional symptoms such as fever, cough and dyspnea
GI sources of chest pain ssx
pain persisting for more than one hour
pain that typically occurs post-prandially
lack of radiation of the pain
associated esophageal sxs (heartburn, regurgitation, dysphagia, pain relieved by antacid ingestion)
Tietze’s syndrome
Defined as a benign, painful, non-suppurative localized swelling of the costosternal, sternoclavicular, or costochondral joints, most often involving the area of the second and third ribs.
Musculoskeletal Etiologies of chest pain
fibromyalgia RA AS Psoriatic arthritis Fractures and subluxations of rib cage
Anxiety
Common source of chest pain
