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Frameworks for IM > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

What are the two categories of Cardiac Chest Pain?

A
  1. ACS

2. Non-ACS

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2
Q

What is ACS?

A

A range of clinical syndromes that result from myocardial ischemia. Diagnosis depends on history, EKG and biochemical markers.

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3
Q

What differentiates myocardial infarction from ischemia?

A

-rise and fall of cardiac biomarkers and characteristic EKG changes

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4
Q

What are the three subtypes of acute coronary syndrome?

A
  1. STEMI
  2. NSTEMI
  3. Unstable Angina
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5
Q

What are the earliest EKG manifestations of STEMI?

A
  • Hyperacute T waves (broad-based, tall, symmetrical) in at least 2 contiguous leads
  • Transient Q waves may also be seen in acute myocardial ischemia
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6
Q

What EKG changes are diagnostic of STEMI?

A

In the appropriate clinical context:

  • new ST elevation at the J point in 2 contiguous leads of >=0.1mV, except in leads V2-V3, where:
    • > =0.2 mV in men 40 y/o
    • > =0.25 mV men < 40
    • > =0.15 mV in women
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7
Q

What’s the EKG progression in STEMI?

A
  1. Hyperacute: Increasing T waves
  2. Acute: ST elevation
  3. Hours: ST elevation, decreasing R wave, Q wave begins
  4. Days 1-2: T wave inversion, Q wave deeper
  5. Days: ST normalizes, T wave inversion
  6. Weeks: ST and T wave normalize. Q wave persists.
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8
Q

What are the EKG findings UA/NSTEMI?

A

EKG characteristics include:

  • new horizontal or downscoping ST segment depression >= 0.05 mV in 2 contiguous leads and/or
  • T-wave inversion >= 0.1 mV in 2 contiguous leads with prominent R wave or R/S ratio > 1.
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9
Q

What things make EKG interpretation of ischemia unreliable and False Positive?

A
  1. Early depolarization
  2. LVH
  3. LBBB
  4. Ventricular paced rhythm
  5. preexcitation
  6. J point elevation syndromes (Brugada)
  7. Acute pericarditis/myocarditis
  8. Subarachnoid hemorrhage
  9. Metabolic disturbance (hyperkalemia)
  10. Stress cardiomyopathy
  11. Cholecystitis
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10
Q

What things make EKG interpretation of ischemia unreliable and False Negative?

A
  1. prior MI with q waves and/or persistent ST elevation
  2. Ventricular paced rhythm
  3. LBBB
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11
Q

How are UA and NSTEMI distinguished?

A
  • Elevated troponin in NSTEMIA

- Dx UA based on Hx;EKG changes may not be present.

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12
Q

Consider this etiology in pregnant ACS patient:

A

Coronary artery dissection

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13
Q

Consider this etiology in young man with cast pain, ST elevation, Positive troponin, and positive urine drug screen.

A

Coronary artery vasospasm, including Pintzmetal’s variant angina.

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14
Q

What are the causes of ACS, including STEMI/NSTEMI/UA?

A
  1. Plaque rupture
  2. Stent thrombosis
  3. Coronary artery embolism
  4. Vasospasm/Printzmetal
  5. Coronary artery dissection
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15
Q

What are risk factors for coronary artery disease?

A
  1. Age
  2. Male
  3. Smoking
  4. HLP
  5. Diabetes
  6. Sedentery
  7. Family history premature CAD
  8. Chronic inflammatory conditions.
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16
Q

What is criteria for positive family history of premature CAD?

A
  • definite MI or sudden death before:
    • 55 male 1st deg relative
    • 65 female 1st deg relative
17
Q

How does timing of stent thrombosis differ between bare metal and drug eluting stents?

A

Stent thrombosis is largely:

  • An early complication of bare metal (<30 days)
  • A late complication of DES (after several years)
18
Q

What’s the most common risk factor for coronary artery embolism?

A

A fib

19
Q

In coronary vasospasm, what risk factor is associated with MI (as opposed to ischemia)?

A

Coronary artery vasospasm is more likely to result in myocardial infarction in patients with underlying CAD.

20
Q

What proportion of coronary artery dissection occurs in peripartum period?

A
  • majority of coronary artery dissections occur in women.

- 1/3 cases occur in peripartum period

21
Q

What are the Cardiac causes of Chest pain that are unrelated to ACS?

A
  1. Stable angina pectoris
  2. Aortic stenosis
  3. Pericarditis/Myocarditis
  4. Aortic dissection
  5. Vasospasm
  6. HOCM
  7. Mitral valve prolapse

Frameworks for IM (2 decks)

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