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Emergency Medicine > Chest Pain > Flashcards

Chest Pain Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

6 life threatening causes of CP

A 
ACS
PE
Aortic dissection
Esophageal rupture
Tension pneumothorax 
Pericardial tamponade
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2
Q

Common non-life threatening

A 
gastrointestinal 
pulmonary (pneumonia or pleurisy)
chest wall syndromes (musculoskeletal pain)
psychiatric
shingles
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3
Q

the main trifecta of

A

a. Myocardial Infarction (cardiac ischemia)
b. Pulmonary Embolism
c. Aortic Dissection

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4
Q

exertion related pain that is consistent

A

Angina! (CAD)

i went out yesterday i usually walk three block before experiencing some discomfort

If fully occlude –>you’ve had a STEMI

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5
Q

main and other RF for Angina and CAD

A 
males greater than 45
women >55
trasnfats and cholesterol 
family
DM
HTN
Smoking

a. Stress, depression, insomnia
b. Amphetamine/cocaine use
c. ESRD
d. Connective tissue disease (SLE, RA)
e. Vasculitis
f. HIV/HAART medications
g. Trauma
h. Any condition where O2 demand exceeds supply (GI bleed, sepsis)

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6
Q

for stable angina, how do you target with questions

A

ask about pain
what were you doing yesterday and last week and last year

need to get a progressive HX of sxs

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7
Q

unstable angina differs from stable

A

class III or class IV

at leas than two blocks or one flight of stairs

significant atherosclerosis
keep for stress test or send to cardiology

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8
Q

when ruling out ACS what are you ruling out exactly

A

want to rule out a STEMI and NSTEMI

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9
Q

three patterns of STEMI

A
  1. ST Depressions
  2. T wave inversions
  3. Wellens’ pattern
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10
Q

Definition of a NSTEMI

A

troponin increase in the absence of strict ECG criteria

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11
Q

2 Different causes for NSTEMI

A

2/3rds of the time supply/demand mismatches

can have this occur in sepsis with troponin release

can also be severely anemic and not have adequate oxygen delivery

1/3 occurs with occlusive myocardial infarction

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12
Q

NSTEMI tx

A

balloon, stent, thrombolitic

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13
Q

cardiogenic shock

A

hypotension and hypoprofusion associated with MI

due to MI or in the setting of cardiac dysfunction resulting form smaller events

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14
Q

AMI RF

A

EVERYONE

if you suspect MI get a troponin

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15
Q

common sxs with MI

A

CP does not radiate to legs but will radiate to back neck jaw shoulder and arms

sudden onset

can also see with dyspnea
syncope
nausea
vomitting
extreme weakness
diaphoresis
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16
Q

ATYPICAL sxs of MI seen in this population

A

Women,

diabetics (b/c of neuropathy and visceral nerves have been dulled)

elderly, barriers to communication

(language, dementia, altered mental status/psych)

17
Q

atypical sxs of MI

A 
N/V
cold sweats
SOB
fatigue
syncope
cold and clammy
back pain palpitations
18
Q

what two medications can not be used to rule in or rule out cardiac related CP

A

NTG–> will relieve non related CP

GI cocktail–> will relieve MI

19
Q

current STEMI standard criteria

A

any ST segment elevation of over 1mm in all leads other than V2 or V3

20
Q

how to

A

II,III,AVF

I and AVL (lateral)

21
Q

v1,v2,v3,v4 depression

A

inferior wall MI

22
Q

all pts coming in with CP with suspicion of MI

A

i. IV – 2 large PIVs
ii. O2 – Nasal Cannula (could be harmful)
iii. Cardiac monitor – HR/rhythm + BP
iv. At least 2 sets of EKGs/biomarkers

23
Q

b. STEMI Treatment

A

i. Cath lab as soon as possible
ii. Balloon angioplasty or stent
iii. May need bypass surgery if severe or multi-vessel disease
iv. Thrombolytics only if delay in transferring to STEMI center

24
Q

NSTEMI/Unstable Angina Treatment

A

Aspirin - 162mg, NON-enteric coated, chewable
1.Mortality benefit

2.4-5% mortality benefit

Additional anti-platelet agents (e.g. clopidogrel/plavix preferred)

LMWH
small benefit
Nitroglycerin
1. Except in hypotension/R sided MI/recent phosphodiesterase use

analgesia-opiates

25
Q

once admitted

A
  1. High dose statin (Atorvastatin)
  2. Beta blockers (after 24 hours) – don’t give in acute phase

`3.ACE Inhibitors (when stable)
VI. Disposition

26
Q

when would you give BB

A

Not acute–> associated with cardiogenic shock

initially just plavex and ASA send to cath lab

maybe second day

27
Q

AD high risk conditions

A

Marfans syndrome
connective tissue disease

family history of aortic disease

known aortic valve disease

recent aortic manipulation

28
Q

high risk pain features of AD

A

chest, back or abdominal pain described as the followingL abrupt in onset, severe in intensity and ripping/tearing or sharp quality

29
Q

High risk exam features for AD

A

evidence of a perfusion deficit (pulse deficit, systolic BP differential, focal neurologic deficit- in conjunction with pain )

murmur of aortic insufficiency

hypotension or shock state

30
Q

what is the CM of AD

A

sharp,
knife like
ripping or tearing pain

syncope

on exam a pulse deficit
new diastolic murmur
focal neurological deficit

hypotension that may be related to cardiac tamponade, aortic valve regurgitation, acute myocardial infarction

31
Q

whta type of focal neurological deficit would you expect to see in pt with AD

A

stroke, ALOC, horner syndrome, haorseness, acute paraplegia from spinal cord ischemia

32
Q

most common population with AD

A

HTN (80%)
▪ most important
predisposing factor

MC Age 50-60y

33
Q

AD diagnostics

A

CXR
▪ widening of mediastinum (classic)

MRI Angiography → Gold standard

CT with contrast
▪ becoming test of choice

Transesophageal echo

ADD-RS plus D-dimer
(low risk with neg D-dimer–> you’re good)
either one high might need a negative D dimer

34
Q

management of AD

A

ED management is lowering the HR and BP
HR<60 SBP 100-120
opiates for pain control

Surgical management
▪ Ascending or
▪ Descending with complications

Medical management
▪ Descending if no complications
- B-blockers 1st line: Esmolol, Labetolol

Emergency Medicine (28 decks)

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