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PSP > Chest Pain > Flashcards

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
Q

1stt type AV block

A

. PR interval long (>200 ms)

. Each big box is 200ms/0.2s

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26
Q

2nd type I AV block

A

. PR gets longer and longer then loses a beat

. Regularly irregular

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27
Q

2nd type II AV block

A

. PR normal

. Lose a beat

28
Q

3rd type V block

A

. P waves and QRS independent of each other

29
Q

Tachycardia

A

. 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
Q

MI

A

. 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
Q

Troponin vs CKMB

A

. 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
Q

PVC

A

Premature ventricular contraction

QRS>0.12, very larger and widened

33
Q

PAC

A

Premature atria contraction
Contains P-wave from atria
. QRS <0.12
. Very short

34
Q

Most common EKG finding in in PTE

A

Sinus tachycardia

35
Q

PTE risk factors

A 
. Recent trauma
. Surgery
. Travel
. Obesity/sedentary lifestyle 
. Cancer
36
Q

D-dimer

A 
. 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
Q

Aortic dissection

A

. 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
Q

GERD improves w/ ___

A

. Antacids
. H2 blockers
. Proton pump inhibitors

39
Q

Costochondritis

A

. 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
Q

Herpes zoster treatments

A

. Acyclovir, valacyclovir, narcotics

41
Q

massive PE

A

Hypotension and shock are markers

Clot so big it affects the heart

42
Q

Right sided murmurs will increase with ____

A

Inspiration

43
Q

Guide to murmur diagnosing

A 
. Systolic or diastolic 
. L/R sided in origin
. Characteristics (crescendo, holosystolic)
. Location
. Radiation
44
Q

Systolic murmur and causes

A

. 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
Q

Mitral regurgitation

A

. Incompetent valve
. Abnormal leaking of blood from LV into LR
. Causes: myxomatous degeneration, MI, dilated LV
. Sounds holosystolic that radiates to axilla

46
Q

Tricuspid regurgitation

A

. 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
Q

VSD

A

. 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
Q

Aortic stenosis

A

. 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
Q

T/F diastolic murmurs are always pathologic

A

T

50
Q

Diastolic murmurs

A

. Swoosh right after S2 and before S1
. Blood having trouble leaving atrium to ventricle because mitral stenosis
. Aortic regurgitation

51
Q

Aortic regurgitation

A

. 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
Q

Austin flint murmur

A

. Vibration of ant. Leaflet of mitral valve as it is buffetted simultaneously by blood jets from LA and aorta

53
Q

Mitral stenosis

A

. 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
Q

PR interval

A

. Time from stimulus of atria to stimulation of ventricle (0.12-0.2 s)

55
Q

QRS complex

A

Spread fo stimulus through ventricle

56
Q

Hypertrophic cardiomyopathy

A

Hypertrophic ventricular septum on side of LV
. Gets louder w/ valsalva (standing)
. Due to genetic predisposition

57
Q

Fixed split S2 (ASD)

A

. 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
Q

Pericardial rub

A

. 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
Q

Sinus arrhythmia

A

. Time difference btw P-waves is highly variable

60
Q

What Standing or valsalva test does to heart

A

. Decreases venous return (dec. preload)

61
Q

What does hand grip test do to heart?

A

. Inc vascular resistance (inc. preload and afterload)

62
Q

What does squatting test do to heart?

A

. Inc. afterload

. Highly inc. preload

63
Q

Aortic stenosis murmur volume standing, hand grip, and squatting tests

A

. Standing: dec
. Hand grip: dec.
. Squatting: inc.

64
Q

hypertrophic cardiomyopathy (HOCM) murmur volume standing, hand grip, and squatting test results

A

. Standing inc.
. Hand grip dec.
. Squatting dec.

65
Q

mitral valve prolapse (MVP) murmur volume standing, hand grip, and squatting test results

A

. Standing inc.
. Hand grip dec.
. Squatting dec.

66
Q

What murmurs get louder w/ valsalva

A

HOCM and MVP

PSP (35 decks)

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