Chest pain Flashcards
What are some ddx for chest pain?
Anxiety Aortic stenosis Pericarditis Pleuritis Myocarditis Cardiomyopathy Aortic dissection Asthma Esophagitis Gastroenteritis MI PE Cardiac tamponade HTN emergency Skin- lac or shingles
What is the flow chart for Acute coronary syndrome?
- Non cardiac
- Stable angina
- Unstable angina
- Definite ischemic event
What is the classic presentation of MI?
Pt presents early AM with substernal achy pressure
- Radiated pain to ant neck, shoulder, left arm, back and jaw
- 50% only have chest pain
- SOB
- Nausea
- Sweating
What are some classic risk factors for MI?
Past hx of CAD
- Smoking
- HTN
- Hypercholesterolemia
- DMD
- Family hx of CAD
- Elevated CRP
At what ages is family hx relevant?
Father
Do women and young present with typical or atypical sx’s?
No they do not
- No pain
- SOB
- sweaty
- Syncope
- Palpitation
- indigestion
- weakness
What does a new murmur suggest with a pt with chest pain?
MI which caused a papillary muscle rupture
What looks the same about in EKG as NSTEMI?
Unstable angina
Do most STEMI’s have q waves or no?
Most do
- Not definitive to rule it a STEMI if Q waves present though
- STEMI’s can also show up without Q waves
What are some characteristics of stable angina?
Can be very frequent
Not always predictive of CAD in women (only 50-60%)
- Men 80-99% predictive
What is Prinzmentals angina?
Vasospasm
- Ass with ST elevations
- Occurs at rest and often at night
- Rarely during exercise
What is unstable angina?
Increases in duration, freq and intensity
- New ass sx’s
- Occurring with increasingly less activity at rest
What is Grade I angina?
Ordinary physical activity does not cause angina such as walking or climbing stairs but very strenuous rapid or prolong exertion can evoke it
What is grade IV angina?
Inability to carry our any physical activity
- angina at rest
Criteria for defining an MI?
Elevated trop and at least 1 of the following:
- Sx of ischemia
- Q wave dev
- New ST/T wave changes or new LBBB
- Intracornary thrombus
- Loss of cardiac wall (echo)