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Chest Pain Flashcards

1
Q

Common and concerning symptoms related to chest pain

A 
. Shortness of breath 
. Exertional complaints
. Palpitations 
. Fainting/near fainting spell
. Edema
. Orthopnea
. Hemoptysis
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2
Q

Pleura components

A

. Visceral/parietal pleura

. Pleural space

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3
Q

Pleuritic pain

A

. Pain w/ deep breathing

. Many conditions related w/ this

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4
Q

Important questions to ask w/ chest pain

A 
. What kind of pain 
. Quality of pain
. Severity 
. Any radiation
. Any prior episodes
. Any assoc. symptoms
. Any exertional symptoms
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5
Q

How to create differential diagnosis

A 
. Detailed past medical/surgery/family history 
. Medications
. Social history 
. Understanding of patient’s complaint
. OB/GYN history and pregnancy
. Life style choices 
. Recent travel
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6
Q

Reasons chest pain is diaphragm

A

. Water pus, or blood in diaphragm

. From injury, infection, TB, cancer, ectopic pregnancy

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7
Q

What ethnicity is higher risk for MI

A

Asian women because of small coronaries

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8
Q

Differential diagnoses for chest pain

A 
. Angina: pain related to cardiac disease
. MI
. PE
. Pericarditis: inflammation of pericardial sac
. Aortic dissection
. Shingles
. Musculoskeletal 
. GERD
. Pneumothorax
. Panic disorder
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9
Q

Systole

A 
. Ventricles contract raises pressure 
. A/V valves close making S1
. Pressure continues to inc. 
. Aorticpulmonic valves open 
. Blood ejected into arteries
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10
Q

Diastole

A 
. Aortic/pulmonic valves close (S2)
. A/V valves open 
. Blood moves from atria to ventricles 
. Atria contract as ventricles almost filled 
. Causes complete emptying of atria
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11
Q

Aortic post

A

R 2nd intercostal space (R upper sternal border)

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12
Q

Pyloric post

A

L 2nd intercostal space

. Left supper sternal post

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13
Q

Tricuspid

A

L lower sternal border

4th intercostal on left

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14
Q

Mitral valve

A

L 5th intercostal space

. Midclavicular

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15
Q

Grades of murmur

A

1: Faint, barely audible
2: soft, but audible
3: moderately loud
4: loud w/ assoc. thrill
5: very loud and thrilling, audible w/ diaphragm on end
6: very loud, thrill, audible w/ stethoscope off Chest

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16
Q

Innocent murmur

A 
. Err less sound made by blood circulating in heart 
. In children 
. Short and soft, grade 2 or less
. Systolic ejection murmur 
. Normal S1-2
. Normal cardiac impulse 
. No hemodynamic abnormality
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17
Q

Split S2

A

. Physiological split S2
. Natural delay in closure of pulmonic valve
. Inc. venous return to right side of heart delays closure

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18
Q

Midsystolic murmur causes

A

. Aortic stenosis
. Pulmonary stenosis
. Atrial septal defect
. HOCM

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19
Q

Holosystolic murmur cause

A

. Mitral regurgitation
. Tricuspid regurgitation
. Vid

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20
Q

Late systolic murmur cause

A

Mitral valve prolapse

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21
Q

Early diastolic murmur causes

A

. Aortic regurgitation
. Pulmonic regurgitation
. Austin-Flint

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22
Q

Mid/late diastolic murmur causes

A

. Sitral stenosis

. Tricuspid stenosis

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23
Q

Rare murmur cause

A

Patent ductus arteriosus

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24
Q

ECG

A

. Records depolarization/depolarization
. Doesn’t record contraction of heart
. P-wave spread of stimulus through the atria
. PR interval: time from stimulus of atria to stimulation of ventricle
. QRS complex: depolarization of ventricle, depolarization of atria (not visible)
. ST segment/T wave: return of stimulated ventricular muscle to resting state (ventricular repolarization)
. TP segment: ventricles depolarizer, ready for next depolarization, used as baseline to compare for ST elevation/depression, PR depression

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25
1stt type AV block
. PR interval long (>200 ms) | . Each big box is 200ms/0.2s
26
2nd type I AV block
. PR gets longer and longer then loses a beat | . Regularly irregular
27
2nd type II AV block
. PR normal | . Lose a beat
28
3rd type V block
. P waves and QRS independent of each other
29
Tachycardia
. A fib: QRS not spaced out equally, no discernible P waves . A flutter: saw tooth pattern . Supraventricular tachycardia (AVNRT, AVRT, WPW) . Ventricular tachycardia, fibrillation, tornados de pointes
30
MI
. Blockage of 1 of the vessels feeding the heart . Chest pain, diaphoresis, dyspnea . Risk factors: hypertension, hyperlipidemia, DM, smoking, alcohol, stress . EKG shows ST elevation
31
Troponin vs CKMB
. Troponin most sensitive, much higher levels released in MI . CKMB: in cardiac tissue, good test only if skeletal muscle isn’t damaged, lower concentration available for less amount of time
32
PVC
Premature ventricular contraction | QRS>0.12, very larger and widened
33
PAC
Premature atria contraction Contains P-wave from atria . QRS <0.12 . Very short
34
Most common EKG finding in in PTE
Sinus tachycardia
35
PTE risk factors
``` . Recent trauma . Surgery . Travel . Obesity/sedentary lifestyle . Cancer ```
36
D-dimer
``` . Fibrin degradation product . Signifies that clot was formed recently . Has great negative predictive value . Non-specific if positive . Good to rule out DVT/PE ```
37
Aortic dissection
. Tear in innner layer of aorta . Blood pools in wall . Obstructs arteries feeding the brain causing syncope . Symptoms: crushing chest pain radiating to back . Can cause tachycardia, hypotension, dec. perfusion to kidneys
38
GERD improves w/ ___
. Antacids . H2 blockers . Proton pump inhibitors
39
Costochondritis
. Inflammation of sternocostal joints . Caused by viral URI, excessive coughing, minor trauma . Chest pain/tenderness to palpation of sternum/ribs . Improves w/ anti-inflammatories
40
Herpes zoster treatments
. Acyclovir, valacyclovir, narcotics
41
massive PE
Hypotension and shock are markers | Clot so big it affects the heart
42
Right sided murmurs will increase with ____
Inspiration
43
Guide to murmur diagnosing
``` . Systolic or diastolic . L/R sided in origin . Characteristics (crescendo, holosystolic) . Location . Radiation ```
44
Systolic murmur and causes
. Swooshing sound . Occur right after S1 (closing of mitral) and before S2 (closing of aortic) . Aortic stenosis, mitral regurgitation, VSD (hole in interventricular septum and blood crosses to high pressure side to low pressure side)
45
Mitral regurgitation
. Incompetent valve . Abnormal leaking of blood from LV into LR . Causes: myxomatous degeneration, MI, dilated LV . Sounds holosystolic that radiates to axilla
46
Tricuspid regurgitation
. Incompetent valve . Abnormal leaking of blood from RV to RA . Causes: myxomatous degeneration, inc. R sided pressures . Sounds: holosystolic, inc. w/ inspiration, no radiation
47
VSD
. Congenital hole in septum . L heart pressure high than right . In systole, heart contracts and blood in left goes across into right side . Sounds: holosystolic like mitral, over sternal border
48
Aortic stenosis
. Valve narrows creating turbulent flow . Result: heart has to work hard by creating pressure to get blood across stenotic valve . Causes: congenitally bicuspid valve, wear and tear from age, rheumatic fever . Sound: crescendo-decrescendo murmur in systole, radiates to carotid
49
T/F diastolic murmurs are always pathologic
T
50
Diastolic murmurs
. Swoosh right after S2 and before S1 . Blood having trouble leaving atrium to ventricle because mitral stenosis . Aortic regurgitation
51
Aortic regurgitation
. Valve doesn’t close . Blood comes back into heart . Causes: congenitally bicuspid valve, rheumatic disease . Sounds: turbulence in diastole after S2, upper sternal and radiates inf. . Best heard w/ patient sitting up and leaning forward in expiration
52
Austin flint murmur
. Vibration of ant. Leaflet of mitral valve as it is buffetted simultaneously by blood jets from LA and aorta
53
Mitral stenosis
. Blood can’t get out of L atrium . Occurs when valve is less than 2 cm wide . Causes pressure gradient across valve and turbulence . Causes: rheumatic heart disease, damage from endocarditis . Sounds: mid-diastolic rumbling murmur will be heard after opening snap, best heard in apical region, doesn’t radiate
54
PR interval
. Time from stimulus of atria to stimulation of ventricle (0.12-0.2 s)
55
QRS complex
Spread fo stimulus through ventricle
56
Hypertrophic cardiomyopathy
Hypertrophic ventricular septum on side of LV . Gets louder w/ valsalva (standing) . Due to genetic predisposition
57
Fixed split S2 (ASD)
. Inc. pulmonary blood flow from inc. preload from L to R shunt of blood across ASD delays closure of pulmonic valve . Split doesn’t change w/ respiration . ASD more hemodynamically significant than small inc. in volume of blood that results from inspiration
58
Pericardial rub
. Means pericarditis from recent upper resp. Tract infection (chest pain better w/ leaning forward and worse w/ lying down) . Velcro sound that you hear throughout cardiac cycle
59
Sinus arrhythmia
. Time difference btw P-waves is highly variable
60
What Standing or valsalva test does to heart
. Decreases venous return (dec. preload)
61
What does hand grip test do to heart?
. Inc vascular resistance (inc. preload and afterload)
62
What does squatting test do to heart?
. Inc. afterload | . Highly inc. preload
63
Aortic stenosis murmur volume standing, hand grip, and squatting tests
. Standing: dec . Hand grip: dec. . Squatting: inc.
64
hypertrophic cardiomyopathy (HOCM) murmur volume standing, hand grip, and squatting test results
. Standing inc. . Hand grip dec. . Squatting dec.
65
mitral valve prolapse (MVP) murmur volume standing, hand grip, and squatting test results
. Standing inc. . Hand grip dec. . Squatting dec.
66
What murmurs get louder w/ valsalva
HOCM and MVP

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