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Emergency Med > Chest Pain > Flashcards

Chest Pain Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Six causes of life-threatening chest pain:

A
  1. Acute MI/coronary syndrome
  2. Pulmonary embolism
  3. Aortic embolism
  4. Tension pneumothorax
  5. Pericardial tamponade
  6. Esophageal rupture
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2
Q

Leading cause of death in the US

A

Acute coronary syndrome (ACS)

Any condition brought on by a sudden reduction or blockage of blood flow to the heart.

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3
Q

Define angina pectoris (stable)

A

Discomfort induced by exercise and relieved with rest or nitroglycerin

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4
Q

Define unstable angina

A

More frequent, longer episodes, more easily provoked

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5
Q

Define atypical or prinzmetal angina

A

Angina that occurs at rest

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6
Q

Four high risk ssx for ACS

A
  1. Pressure/squeezing
  2. Pain similar to prior AMI/angina
  3. Radiation to neck, shoulders or left arm
  4. Dyspnea
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7
Q

What should be noted in the workup of ACS?

A

Evaluate hemodynamic status
Vital signs
Skin color

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8
Q

What should you consider with bradycardia in the setting of chest pain?

A

Inferior MI

Medication induced bradycardia with supra-therapeutic level of AV node blocking medication

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9
Q

The leading cause of death for both men and women worldwide

A

Ischemic heart disease

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10
Q

Risk factors for ACS

A
  1. Previous CV disease
  2. Older age
  3. Tobacco smoking
  4. High LDL/triglycerides and low HDL
  5. Diabetes
  6. High BP
  7. Lack of physical activity
  8. Obesity
  9. Chronic kidney disease
  10. Alcohol/drug use
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11
Q

Differentiating SSX for aortic dissection

A

Unequal pulses
Pain radiating to the back
New murmur of aortic insufficiency

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12
Q

Differentiation SSX for cardiac tamponade

A

Beck’s triad:
Low BP
Distended neck veins
Distant, muffled heart sounds

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13
Q

Differentiating SSX for pneumothorax

A

Decreased breath sounds

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14
Q

ACS most frequently occurs as a consequence of one of what three conditions?

A

ST elevation MI (STEMI)
Non-ST elevation MI (Non-STEMI)
Unstable angina

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15
Q

The pathophysiology behind ACS is primarily due to what?

A

Endothelial injury and plaque formation that usually ruptures at sites of greatest mechanical stress

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16
Q

Although ACS is usually associated with coronary thrombosis, it can also be associated with what?

A

Use of cocaine and methamphetamine

17
Q

What are the most often used blood markers for MI?

A

Creatine kinase-MB (CK-MB) fraction and Troponin levels

18
Q

What is the immediate treatment for suspected acute MI?

A

Oxygen
Aspirin
Sublingual nitroglycerin

19
Q

How are most cases of MI with ST elevation treated?

A

Reperfusion therapy (percutaneous coronary intervention or thrombolytic drugs)

20
Q

Beside MI, what can also result in release of Troponin?

A

Carbon monoxide or cyanide poisoning due to hypoxic cardiotoxic effects
Right ventricular strain and ischemia from hypertension, embolism, or acute exacerbation of chronic obstructive pulmonary disease
COPD can be concurrent with MI

21
Q

With an MI, when is Troponin elevated? (early, middle or late)

A

Late

22
Q

What is the immediate treatment for acute coronary syndrome?

A

MONA - morphine, oxygen, nitroglycerin, aspirin

23
Q

What is the definition of aortic aneurysm?

A

A general term for any swelling of the aorta >1.5 times normal usually representing an underlying weakness in the wall

24
Q

What are the SSX of aortic aneurysm?

A

Discomfort (risk of rupture -> severe pain, hemorrhage, death)
Hoarse voice due to compression of left recurrent laryngeal nerve

25
Q

What is cardiac tamponade?

A

The buildup of fluid, usually urea, inside the pericardium.

26
Q

Beside Beck’s triad, what are some other SSX of tamponade?

A

Pulsus paradoxus
Tachycardia
Dyspnea
Decreasing level of consciousness

27
Q

When should pulmonary embolism be suspected?

A

In any patient who presents with chest pain that is usually, but not necessarily pleuritic or dyspnea not explained by evaluation

28
Q

What are the SSX of pulmonary embolism and why are they not very useful?

A 
Dyspnea
Pleuritic chest pain
Cough 
Hemoptysis
Not very useful because frequency is similar among pts w/ and w/o PE
29
Q

What is the gold standard for diagnosing pulmonary embolism?

A

Pulmonary angiography

30
Q

What test is useful with suspicion of DVT, PE, or DIC?

A

D-dimer

31
Q

What is the criteria for a Wells score (for relative risk

of pulmonary embolism)?

A 
Clinical suspicion of DVT (3)
Alt Dx less likely than PE (3)
Tachycardia (HR>100) (1.5)
Immob. > 3d / Surg. in last 4 wks (1.5)
Hx of DVT/PE (1.5)
Hemoptysis (1)
Malignancy (tx w/in 6 mos) (1)
>6 high risk,
32
Q

What condition is a medical emergency that can cause steadily worsening levels of arterial oxygen concentration and low BP that if not reversed by tx can cause death?

A

Pneumothorax

33
Q

What are the SSX of tension pneumothorax?

A

Chest pain
Respiratory distress
>HR
Tachypnea
Displacement of trachea away from affected side
Quieter breath sounds on one side of the chest

34
Q

What condition may have chest pain with fever, cough, and dyspnea?

A

Pneumonia

35
Q

What condition is defined as a benign, painful, nonsuppurative localized swelling on the costosternal, sternoclavicular, or costochondral joints?

A

Tietze’s syndrome

Emergency Med (8 decks)

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