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Cardiology > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

Myocardial Ischemia causing chest discomfort. Harrison’s 19th edition page 95

A

Angina Pectoris

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2
Q

Precipitated by imbalance between myocardial oxygen requirements and myocardial oxygen supply, resulting in insufficient delivery of oxygen to meet the heart’s metabolic demands. Harrison’s 19th edition page 95

A

Myocardial Ischemia

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3
Q

Determinants of myocardial oxygen consumption. Harrison’s 19th edition page 95

A

Heart rate
Ventricular wall stress
Myocardial contraction

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4
Q

Determinants of myocardial oxygen supply. Harrison’s 19th edition page 95

A

Coronary blood flow

Coronary arterial oxygen content

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5
Q

Ischemic heart disease is most commonly caused by? Harrison’s 19th edition page 96

A

Atheromatous plaque

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6
Q

Duration of myocardial ischemia to result in MI or irreversible cellular injury. Harrison’s 19th edition page 96

A

20 minutes

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7
Q

Ischemic episodes that are typically precipitated by a superimposed increase in oxygen demand during physical exertion and relieved upon resting. Harrison’s 19th edition page 96

A

Stable Angina

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8
Q

Coronary thrombosis triggered by rupture or erosion of one or more atherosclerotic lesions and is characterized as presence or absence of detectable myocardial injury and the presence or absence of ST-segment elevation on the patient’s ECG. Harrison’s 19th edition page 96

A

Unstable ischemic heart disease

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9
Q

Classification of Unstable ischemic heart disease. Harrison’s 19th edition page 96

A

Unstable Angina
Non-ST elevation MI
ST elevation MI

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10
Q

Unstable ischemic heart disease with no detectable myocardial injury. Harrison’s 19th edition page 96

A

Unstable angina

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11
Q

Unstable ischemic heart disease with evidence of myocardial necrosis. Harrison’s 19th edition page 96

A

Non-ST elevation MI (NSTEMI)

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12
Q

Transmural myocardial ischemia caused by a coronary thrombus that is acutely and completely occlusive with ST-segment elevation on ECG and myocardial necrosis. Harrison’s 19th edition page 96

A

ST elevation MI (STEMI)

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13
Q

Ischemia precipitated by acute coronary atherothrombosis. Harrison’s 19th edition page 96

A

Acute Coronary Syndrome

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14
Q

Acute Coronary Syndrome. Harrison’s 19th edition page 96

A

Unstable angina
NSTEMI
STEMI

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15
Q

Myocardial Ischemia precipitated by exertion, cold or stress. Harrison’s 19th edition page 97

A

Stable angina

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16
Q

Exertional chest discomfort that occurs at increased frequency with progressively lower intensity of physical activity or even at rest. Harrison’s 19th edition page 97

A

Unstable angina

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17
Q

Exertional chest discomfort that usually begins gradually and reaches its maximal intensity over a period of minutes before dissipating within several minutes with rest or with nitroglycerin. Harrison’s 19th edition page 97

A

Stable angina

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18
Q

Chest discomfort that is typically severe and prolonged usually lasting >30mins and is not relieved by rest. Harrison’s 19th edition page 97

A

Myocardial infarction

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19
Q

Chest discomfort characteristic of myocardial ischemia. Harrison’s 19th edition page 97

A 
Aching
Heavy
Squeezing
Crushing
Constricting
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20
Q

Usual site of chest discomfort in Myocardial ischemia. Harrison’s 19th edition page 97

A

Retrosternal

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21
Q

Usual site of radiation of the chest discomfort in Myocardial ischemia. Harrison’s 19th edition page 97

A 
Ulnar surface of the left arm
Right arms
Both arms
Neck
Jaw
Shoulders
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22
Q

Associated features in Myocardial Ischemia. Harrison’s 19th edition page 96

A

S4 gallop (pain)
Mitral regurgitation (pain)
S3 (severe ischemia or complication)
Rales (severe ischemia or complication)

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23
Q

Pathophysiology of referred cardiac pain. Harrison’s 19th edition page 97

A

Cardiac sympathetic afferent impulses converge with impulses from somatic thoracic structures.

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24
Q

Pathophysiology of anginal pain radiating to the neck. Harrison’s 19th edition page 97

A

Cardiac vagal afferent fibers synapse in the nucleus tractus solitatrius (medulla) descend to the upper cervical spinothalamic tract

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25
Q

Radiation to right arm or shoulder.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Increased

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26
Q

Described as pressure.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Increased

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27
Q

Inframammary location

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Decreased

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28
Q

Associated with diaphoresis.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Increased

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29
Q

Described as pleuritic.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Decreased

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30
Q

Described as sharp.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Decreased

31
Q

Radiation to both arms or shoulders.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Increased

32
Q

Reproducible with palpation.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Decreased

33
Q

Associated with exertion.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Increased

34
Q

Radiation to left arm.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Increased

35
Q

Associated with nausea or vomiting.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Increased

36
Q

Worse than previous angina or similar to previous MI.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Increased

37
Q

Described as positional.

Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99

A

Decreased

38
Q

Characteristics of chest pain that increases the likelihood of AMI. Harrison’s 19th edition page 99

A 
Radiation to the right arm or shoulder
Radiation to both arms or shoulder
Associated with exertion
Radiation to the left arm
Associated with diaphoresis
Associated with nausea and vomiting
Worse than previous angina or similar to previous MI
Described as pressure
39
Q

Characteristics of chest pain that increases the likelihood of AMI. Harrison’s 19th edition page 99

A 
Inframammary location
Reproducible with palpation
Described as sharp
Described as positional
Described as pleuritic
40
Q

Chest pain in pericarditis. Harrison’s 19th edition page 97

A

Associated with pleural inflammation
Pleuritic
Exacerbated by breathing, coughing and changes in position

41
Q

Pathophysiology of radiation pain to the shoulder and neck. Harrison’s 19th edition page 97

A

Overlapping supply of central diaphragm via phrenic nerve with somatic sensory fibers from 3rd and 5th cervical segments

42
Q

Pathophysiology of radiation pain to the upper abdomen. Harrison’s 19th edition page 97

A

Lateral diaphragm

43
Q

Form of cardiomyopathy that is triggered by an emotional or physical stressful event and may mimic AMI. Usually seen in women > 50 years of age. Harrison’s 19th edition page 97

A

Takotsubo cardiomyopathy

44
Q

5 high risk conditions with acute chest pain that warrants urgent evaluation and management. Harrison’s 19th edition page 98

A 
ACS
Acute aortic syndrome
Pulmonary embolism
Tension pneumothorax
Pericarditis with tamponade
45
Q

Involves a tear in the aortic intima resulting in separation of the media and creation of a separate “false” lumen. Harrison’s 19th edition page 97

A

Aortic Dissection

46
Q

Ulceration of an aortic atheromatous plaque that extends through the intima and into the aortic media, with potential to initiate an intramedial dissection or rupture into the adventitia. Harrison’s 19th edition page 97

A

Penetrating ulcer

47
Q

Aortic wall hematoma with no demonstrable intimal flap, no radiologically apparent intimal tear, and no false lumen. Harrison’s 19th edition page 97

A

Intramural hematoma

48
Q

Cause of intramural hematoma. Harrison’s 19th edition page 97

A

Rupture of the vasa vasorum

Penetrating ulcer

49
Q

Pain of acute aortic syndrome involving the ascending aorta. Harrison’s 19th edition page 97

A

Midline of the anterior chest

50
Q

Pain of descending aortic syndrome. Harrison’s 19th edition page 97

A

Pain in the back

51
Q

Major complications of proximal aortic dissections. Harrison’s 19th edition page 97

A

MI due to compromise of the aortic ostia of the coronary arteries
Acute aortic insufficiency due to disruption of the aortic valve
Pericardial tamponade due to rupture of the hematoma in to the pericardial space

52
Q

Causes of chest discomfort in pulmonary embolism. Harrison’s 19th edition page 98

A

Involvement of the pleural surface of the lung adjacent to a resultant pulmonary infarction
Distention of the pulmonary artery
Right ventricular wall stress and/or Subendocardial ischemia related to acute pulmonary hypertension.

53
Q

Associated symptoms in Massive or submassive pulmonary embolism. Harrison’s 19th edition page 98

A

Syncope
Hypotension
Right heart failure

54
Q

Chest discomfort in small pulmonary embolism. Harrison’s 19th edition page 98

A

Lateral and pleuritic

55
Q

Chest discomfort in massive pulmonary embolism. Harrison’s 19th edition page 98

A

Severe substernal pain that may mimic MI

56
Q

Risk factors for for pneumothorax. Harrison’s 19th edition page 98

A

Male
Smoking
Family history
Marfan syndrome

57
Q

Type of pneumothorax that occurs in patients with underlying lung disorders. Harrison’s 19th edition page 98

A

Secondary spontaneous pneumothorax

58
Q

Caused by trapped intrathoracic air that precipitates hemodynamic collapse. Harrison’s 19th edition page 98

A

Tension pneumothorax

59
Q

Knifelike pain that is worsened by inspiration or coughing. Harrison’s 19th edition page 98

A

Pleurisy

60
Q

Most common cause of non traumatic chest discomfort. Harrison’s 19th edition page 98

A

Gastrointestinal conditions

61
Q

Costochondral junctions. Harrison’s 19th edition page 98

A

Tietze’s syndrome

62
Q

Relief of angina as they continue at the same or even a greater level of exertion without symptoms. Harrison’s 19th edition page 99

A

Warm-up angina

63
Q

Angina due to redistribution of blood flow to the splanchnic vasculature after eating. Harrison’s 19th edition page 100

A

Postprandial angina

64
Q

A delay of __min before relief is obtained after nitroglycerin suggest that the symptoms either are not caused by ischemia. Harrison’s 19th edition page 100

A

> 10mins

65
Q

Activation of the vagal reflex or stimulation of left ventricular receptors that causes nausea and vomiting in the setting of MI. Harrison’s 19th edition page 100

A

Bezold-Jarisch reflex

66
Q

Clenched fist held against the sternum. Harrison’s 19th edition page 100

A

Levine’s sign

67
Q

Important manifestation of submassive pulmonary embolism. Harrison’s 19th edition page 100

A

Sinus tachycardia

68
Q

Preferred biomarker. Harrison’s 19th edition page 101

A

Cardiac troponin

69
Q

Most useful for identifying pulmonary processes. Harrison’s 19th edition page 101

A

Chest radiograph

70
Q

ECG should be obtained within ___ of presentation of chest pain. Harrison’s 19th edition page 100

A

10 mins

71
Q

Provide early detection of MI defining areas of myocardial necrosis accurately. Harrison’s 19th edition page 102

A

Gadolinium-enhanced Cardiac Magnetic Resonance

72
Q

Employed for completion of risk stratification of patients who have undergone an initial evaluation that has not revealed a specific cause of chest discomfort and has identified them as being at low or intermediate risk of ACS. Harrison’s 19th edition page 101

A

Exercise electrocardiography (“stress testing”)

73
Q

Useful for detecting myocardial ischemia in the absence of STEMI in an ECG. Harrison’s 19th edition page 100

A

ST-segment depression

Symmetric T-wave inversions at least 0.2mV in depth

Cardiology (2 decks)

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