Chest Pain

Question 1

Acute coronary syndrome

Answer 1

Leading cause of death in the US

Represents a spectrum of conditions ranging from chronic stable angina to AMI

Question 2

Angina Pectoris

Answer 2

Discomfort induced by exercise and relieved with rest and/or nitroglycerin

Question 3

New onset angina

Answer 3

Angina that develops within a 2 month time frame

Question 4

Unstable angina

Answer 4

Angina that occurs with more frequent occurrence of anginal episodes, longer lived episodes or more easily provoked angina

Question 5

Atypical or Prinzmental angina

Answer 5

angina that occurs at rest

Question 6

Stable angina

Answer 6

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

Question 7

High risk characteristics for ACS

Answer 7

1. pressure or squeezing quality
2. pain similar to prior AMI or angina
3. radiation to neck, shoulders or left arm
4. associated dyspnea
5. use of drugs such as amphetamines, cocaine, ecstasy

Question 8

Lower risk characteristics for ACS

Answer 8

1. pleuritic quality of pain: sharp/stabbing
2. pain reproducible with palpation or movement
3. pain is of very short duration (seconds)
4. pain is of very long duartion (pain for several hours or even days)

Question 9

Acute Coronary Syndrome Evaluation

Answer 9

Evaluate hemodynamic status
Vitals
Skin color and/or diaphoresis
Bradycardia w/ chest pain should raise concern of an inferior MI

Question 10

ACS Risk factors

Answer 10

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

Question 11

Aortic dissection findings

Answer 11

Unequal pulses
Pain radiating to back
Dvlpmnt of new murmur of aortic insufficiency

Question 12

What three conditions does ACS usually occur as a consequence from?

Answer 12

STEMI (ST elevation myocardial infarction)
Non-STEMI
Unstable angina

Question 13

Pathophysiology behind ACS

Answer 13

Endothelial injury and plaque formation

Question 14

Immediate tx for suspected acute MI

Answer 14

Oxygen
Aspirin
Sublingual nitroglycerin

Question 15

NSTEMI Tx

Answer 15

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

Question 16

Troponin

Answer 16

A relatively late cardiac marker of ACS

Complex of 3 regulatory proteins (Troponin C, Troponin I and Troponin T)

Question 17

How are most cases of STEMI treated?

Answer 17

Reperfusion therapy such as percutaneous intervention (PCI) or Thrombolysis

Question 18

Aortic aneurysm

Answer 18

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

Question 19

Main concern for aortic aneurysm

Answer 19

Risk of rupture –> severe pain, internal hemorrhage and death if not treated immediately

Question 20

Cardiac tamponade

Answer 20

caused by the buildup of fluid inside the pericardium

Question 21

Beck’s Triad

Answer 21

3 signs of classical cardiac tamponade:

1. BP goes down
2. JVD occurs
3. Muffled heart sounds

Question 22

Signs of cardiac tamponade

Answer 22

Beck’s triad
Pulsus paradoxus: drop of at least 10 mmHg in arterial BP on inspiration
Ssxs of shock

Question 23

In which pts should pulmonary embolism be considered in?

Answer 23

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

Question 24

Diagnostic tests for PE

Answer 24

computed tomography pulmonary angiography (CT-PA)
ventilation-perfusion (V/Q) scanning
D-dimer testing
Conventional pulmonary angiography

Question 25

Pneumothorax

Answer 25

Abnormal collection of air or gas in pleural space that separates the lung from the chest wall and which may interfere with normal breathing

Question 26

Primary pneumothorax

Answer 26

Occurs without an apparent cause and in the absence of significant lung dz

Question 27

Secondary pneumothorax

Answer 27

Occurs in the presence of existing lung dz

Question 28

Tension pneumothorax

Answer 28

Medical emergency. | Considered to be present when a pneumothorax leads to significant impairment of respiration and/or blood circulation

Question 29

Most common findings in people with a tension pneumothorax

Answer 29

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

Question 30

Pneumonia

Answer 30

Suspect when there is chest pain accompanied by additional symptoms such as fever, cough and dyspnea

Question 31

GI sources of chest pain ssx

Answer 31

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)

Question 32

Tietze's syndrome

Answer 32

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.

Question 33

Musculoskeletal Etiologies of chest pain

Answer 33

``` fibromyalgia RA AS Psoriatic arthritis Fractures and subluxations of rib cage ```

Question 34

Anxiety

Answer 34

Common source of chest pain