Chest Pain Flashcards
Challenges of MI sx
2.5% of pts with acute MI are sent home
Would rather admit the pts without MI than send someone home who has MI
LIfe threatining chest pain
Acute coronary syndrome Pulmonary embolus Tension penumothorax Aortic dissection Esophageal rupture Pericarditis with tamponade
SOmatic pain
Sensory nerves-spinal nerves…easily localized
Pts will point
Sharp and stabbing
Subdivide into chest wall and pleuritic pain
Visceral pain
Enter via autonomics…poor localiztion
Heart, BV, esophagus and visceral pleaura
Dorsal fibers overlap 3 levels above or below so dz of thoracic origin can produce pain anywhere from jaw to epigastrium
Categorizing chest pain
Chest wall - somatic, sharp and localized…reproducible with palpation and movement
Pleuritc or resp - somatic pain, sharp, worse wit hbreathing and coughing
Visceral - poorly localized, aching, heaviness
MI risk factors and characteristics
Age, DM, etc.
Acute coronary syndromes - history
Typical chest pain - pressurel ike, squeezing, curshing pian, worse with exertion, SOB, diaphoresis, radiates to arm or jaw
Classic angina
Just ate Cold outside Cigarette Older man Levines sign - holding the heart Exertion
Stable angina other presentations
Cold weather, extreme moods, large meals
Dyspnea, N/indigestion, pain in areas other than the chest, palp, syncope
Pericarditis
Sharp, stabbing chest pain
Often 1st sign of other systemic dz
Multiple etiologies, viral and AI most common in US
COnsider TB outside the US
Pericarditis dx
2/4-
Chest pain, friction rub, ECG (wide spread ST elevation with PR depression), pericardial effusion
Consider tamponade (sinus tachy, JVD, pulus paradoxus, Kussmaul’s sign)
Pericaridal tamponade
Low arterial BP
Distended neck veins
Distant muffled heart sounds
Myocarditisi
Most common etiology is viral
HF, chest pain, sudden cardiac death or arrhythmias
ECG, CXR, TTE, cardiac MR and endomyocardial biopsy
Consider in young male with new onset HF
Aortic dissection
Abrupt onset
Pain usually from riping or tearing
New diastolic murmur, asymm pulses and BP
Risk factors - HTN, marfan, coarctation
Widened mediastinum on AP
TEE is dx test of chest
Aortic dissection path
Intimal tear of aorta leads to dissection of layers of aorta creating a false lumen
Aortic dissection dx
Risk factors
Exam - HTN, pulse differentials, neuro defects
Radio - wide mediatinum on CXR, CT angio chest, echo
Tearing chest pain radiating to the back
Pts unlikely to have a dissection if they do NOT have
Acute or tearing or ripping pain
Aortic or mediastinal widening
Asymmetric pulse or BPs
P.E. path
Thrombosis of pulm artery
90% from DVT
Clost travels through venous system and creates a V/Q mismatch
PE hx
Dyspnea is most common
SHarp pleuritc pain with syncope
Prolonged immobiliation, neoplasm, known hypercoagulable disorder
Tension Pneumothorax
COllection of air in the plaural space causes collapse of ipsilateral lung and then CV collapse as intrathoracic pressures increase
Tnesion pnuemo dx and tx
Risk - COPD, connective tissue, trauma, recent instrumentiation, PPV
Absent breath sounds unilaterally, hypotension, distended neck veins, tracheal deviation
Tx - needle decompression, tube throacostomy
Esophageal rupture pathophys
Tear in esophagus leads to leaking of GI contents into mediastinum
Inflammation followed yb infection causes rapid deterioration, sepsis, and death
Esophageal rupture dx
Risk - iatroenic, hevy retching, trauam, foreign bodies, toxic ingestion
Radiology - mediastinal air on plain films or CT scan
Esophagela rupture tx
Antibiotics, supportive, surgical consult
Hammans sign
Crunching sound of the mediastinum
