CHEST PAIN AND SENSORIUM Flashcards
recent onset of pain, pressure, or tightness in the anterior thorax between the xiphoid, suprasternal notch and both midaxillary lines
chest pain
________ includes:
Acute myocardial infarction
acute ischemia/unstable angina
acute coronary syndrome
type of chest pain
retrosternal left anterior chest crushing, squeezing, tightness or pressure
classic features of ACS
Radiation to the neck, arms or jaw
diaphoresis
dyspnea
nausea and vomiting
classic cardiac pain
chest pains lasting for 12-24 hours or more without waxing and waning intensity or pain worsened by specific body movements or positions
non-classic cardiac pain
innervates the chest wall from the dermis to the parietal pleura
pain from somatic fibers is usually easily described, precisely located and often experienced as a sharp sensation
somatic pain fibers
found in the internal organs such as the heart, esophagus and visceral pleura
patients with visceral pain are more likely to use terms such as discomfort, heaviness, pressure, tightness or aching
visceral pain is often referred to an area of the body corresponding to adjacent somatic nerves
visceral pain fibers
angina occurring at rest and that is prolonged usually >20 minutes
rest angina
new onset angina that markedly limits ordinary physical activity
new onset angina
previously diagnosed angina that has become distinct more frequent has a longer duration or is lower in threshold, limiting ability to walk 1-2 blocks or climb 1 flight of stairs
increasing angina
_________ occurs when there is an imbalance of oxygen demand and oxygen supply
ischemia
influenced by the oxygen carrying capacity of the blood and the coronary artery blood flow
oxygen supply
determined by the amount of hemoglobin present and oxygen saturation
oxygen carrying capacityuni
universal sign of ischemic chest pain
defines as an individual holding a clenched fist over the chest that has low sensitivity but is a relatively specific ischemia
levine sign
ST segment elevations in V1, V2 and possibly V3
anteroseptal
ST segment elevations in V1, V2, V3, and V4
anterior
ST segment elevations in V1-V6, I, and aVL
anterolateral
ST segment elevations in I and aVL
Lateral
ST segment elevations in II, III, and aVF
inferior
ST Segment elevations in II, III, aVF, and V5 and V6
inferolateral
medications for ST segment elevation or ischemic ECG
A, C, N, beta, anti-
aspirin
clopidogrel
nitroglycerin
beta blockers
antithrombin
___________ is indicated for patients with STEMI (as a reperfusion option) if time to treatment is <6 to 12 hours from symptom onset and the ECG has at least 1 mm of ST segment elevation in two or more contiguous leads
fibrinolytic therapy
__________ encompass a number of life threatening aortic emergencies
includes:
aortic dissection, penetrating atherosclerotic ulcer, intramural hematoma and aortic aneurysmal leakages
acute aortic syndromes
__________ occurs after a violation of the intima, allows blood to enter the media and dissect between the intimal and adventitial layers
aortic dissection
stanford classification
involvement of the ascending aorta
type A dissection
standford classification
restricted only to descending aorta
type B dissection
debakey
simultaneously involve the ascending aorta, arch and descending aorta
type 1 dissection
debakey
involves only the ascending aorta
type 2 dissection
debakey
involve only the descending aorta
type 3 dissection
a plain _________- may provide important clues for diagnosis
a plain chest xray
imaging modality of choice for diagnosis of dissection
can reliably identify a false lumen and can provide additional details such as anatomy of the dissection, the location of the dissection flap, extension of the flap into great vessels, signs of aortic rupture and signs of end organ damage
ct scan
sensitive and specific as CT
procedure generally has to be performed under moderate sedation or even general anesthesia
transesophageal echocardiography
P wave
atrial depolarization
distant between the onset of P wave to the onset of QRS
PR interval
ventricular depolarization
QRS complex
plateau phase, phase 2 of cardiomyocyte action potential
ST segment
point where ST segment starts
J point
rapid depolarization of contractile sacs
T wave
duration of ventricular depolarization and repolarization
QT interval
______- are not designed to shock flatline (asystole patterns)
defibrillators
the _____ is a test of sensation and if positive may distinguish sensory from motor ataxia
romberg test
the _____- response is the toe that moves upward in response to a mildly noxious stimulation applied to the lateral plantar or lateral aspect of the foot
babinski response
a ____— is an episode of abnormal neurologic function caused by inappropriate electrical discharge of neurons
seizure
_________ is a clinical condition in which an individual is a subject to recurrent seizures
epilepsy
___________ are those in which no evident cause can be identified (type of seizure)
idiopathic seizure
______ are seizures that are a consequence of an identifiable neurologic condition such as mass lesion, previous head injury or stroke
symptomatic seizure
in a typical attack the patient suddenly becomes rigid (tonic phase), trunk and extremities are extended, and patient falls to the ground
generalized tonic clonic seizures
