Chest Pain

Question 1

Myocardial Ischemia

Answer 1

Heart muscle not getting blood it needs

- Due to atherosclerosis, vasospasm, clot, tachy, anemia, hypoxic, LVH (more to perfuse)

Question 2

Myocardial Ischemia sx

Answer 2

L CP can radiate to arm, jaw, epigastric

Question 3

Types of Myocardial Ischemia

Answer 3

• Angina pectoris
• Unstable angina pectoris
• Myocardial infarction

Question 4

Angina Pectoris

Answer 4

Pressure, tightness, squeezing, heaviness, burning

• Precipitated by some activity
• 2-10 min
• Treat w/ rest and/or nitro

Question 5

Unstable angina pectoris

Answer 5

Same sx, a little stronger

• Occurs w/ less activity
• 10-20 min
• Rest and/or nitro, takes longer to resolve

Question 6

Myocardial Infarction

Answer 6

Most severe. Can occur anytime.

• Up to 30 min
• No relief (or mild relief) w/ nitro

Question 7

Aortic Stenosis

Answer 7

Narrowing around aortic valve, flaps become calcified, smaller area for blood to get thru

Question 8

Aortic Stenosis sx

Answer 8

Gradual onset, CP + DOE, dizziness, syncope

Question 9

Aortic Stenosis dx

Answer 9

Echo: systolic murmur at 2nd RICS

Question 10

Aortic Dissection pathophys + sx

Answer 10

Progressive tear in aorta

- Abrupt onset of tearing sharp anterior CP, back, shoulder blade, or abd pain

Question 11

Aortic Dissection dx

Answer 11

• Systolic murmur
• Pericardial rub
• Loss of peripheral pulses
• Hypo or HTN
• CT, MRA, CXR (wide mediastinum)
• EKG (to r/o)

Question 12

Pulmonary Embolism etiology + sx

Answer 12

Usually formed in deep veins of legs

- Abrupt onset CP + SOB, tachy, tachypnea, hypoTN, arrhythmia, syncope

Question 13

Pulmonary Embolism dx

Answer 13

CXR, CT, D-dimer, EKG (S1Q3T3)

Question 14

Pericarditis etiology + sx

Answer 14

Inflam of pericardial sac

• Sharp pain, worse w/ breathing, coughing, moving
• Improved w/ tripod position

Question 15

Pericarditis dx

Answer 15

• Hx and PE

- EKG, troponin

Question 16

Pulmonary HTN sx

Answer 16

Progressive exertional CP + SOB, pressure, fatigue, syncope, edema

Question 17

Pulmonary HTN dx

Answer 17

EKG, CXR (enlarged RV + pulm arteries), echo, R heart cath

Question 18

Pneumonia sx

Answer 18

Onset is variable. Pleuritic pain, SOB, cough, sputum, fever, rales

Question 19

Pneumonia dx

Answer 19

CXR (infiltrates), CBC, sputum culture

Question 20

Pneumothorax

Answer 20

Collapsed lung

Question 21

Types of Pneumothorax

Answer 21

Spontaneous (Primary and Secondary), Tension, Traumatic

Question 22

Spontaneous Pneumothorax (etiology, sx, dx)

Answer 22

• Sudden rupture of bleb
• Sx: sudden onset pleuritic pain + SOB
• Dx: decreased breath sounds, CXR

Question 23

Tension Pneumothorax (etiology, dx)

Answer 23

• Air in pleural space

- Dx: absent breath sounds, CXR

Question 24

GERD is brought on by:

Answer 24

Acidic food, postprandial recumbency, alcohol, caffeine, stress

Question 25

GERD sx

Answer 25

Burning, tightness, pressure - Can last mins to hrs - Can radiate to upper or middle back

Question 26

GERD dx

Answer 26

pH, upper endoscopy, barium swallow

Question 27

Esophageal spasm

Answer 27

Contractions of esophagus, irregular, uncoordinated

Question 28

Esophageal spasm presentation

Answer 28

Quick (sec or min), pressure, tightness, burning, "food stuck feeling"

Question 29

Esophageal spasm dx

Answer 29

Esophageal manometry, barium swallow

Question 30

Esophageal spasm tx

Answer 30

Nitro will help (vasodilator)

Question 31

Esophageal rupture RF

Answer 31

DM, alcoholic, bulemic

Question 32

Esophageal rupture etiology + sx

Answer 32

Spontaneous perf of esophagus | - SEVERE PAIN, retrosternal pain, will get septic quickly

Question 33

Esophageal rupture dx

Answer 33

CXR, CT, upper endoscopy

Question 34

Esophageal rupture tx

Answer 34

Surg

Question 35

Gall Bladder Disease sx

Answer 35

RUQ pain referred to R shoulder - Worsening or intermittent pain - Burning, pressure - Worse after eating

Question 36

Gall Bladder Disease dx

Answer 36

US, lipase, LFT

Question 37

Musculoskeletal pain etiology

Answer 37

**Main cause of CP** Usually occurs after activity - Cervical disc disease, costochondritis, rib fx, trauma

Question 38

Musculoskeletal pain sx

Answer 38

Aching or sharp pain aggravated by movement (reproducible)

Question 39

Musculoskeletal pain dx

Answer 39

- Hx and PE (reproducible) | - CXR (trauma)

Question 40

Psychiatric

Answer 40

Anxiety, brought on by stress, anger, panic | - Sharp, pressure, palpitations

Question 41

Herpes Zoster

Answer 41

Sharp, burning, dermatome distribution, vesicular rash (later)

Question 42

Evaluation of CP

Answer 42

- EKG - Stabilize: MONA - Do they look sick? - Abnormal vitals? - Risk factors?

Question 43

What causes CP?

Answer 43

- MI - Aortic stenosis - Aortic dissection - 5 P's: pericarditis, pulm embolism, pulm HTN, pneumonia, pneumothorax - GERD - Esophageal spasm - Esophageal rupture - Gallbladder disease - Musculoskeletal - Herpes zoster - Psychiatric