Chest Pain DSA

Question 1

At what age do we consider men and women to have an increased risk factor for CAD?

Answer 1

M: >55 y/o
F: >65 y/o

Question 2

7 potentially lethal causes of CP

Answer 2

Myocardial ischemia
MI
Aortic dissection
PE
PTX - tension
Esophageal rupture
Pericarditis

Question 3

What’s Xanthelasma?

Answer 3

Fat depositions in the eyes and eyebrows and is associated with CAD

Question 4

What are Nicotine Stains?

Answer 4

Yellowish stains on fingers, hair, clothes and is associated with CAD

Question 5

Auscultatory findings associated with CAD (4)

Answer 5

Bruits - turbulent sounds in carotid aa. and femoral aa.
S4 gallop - during angina attack
S3 gallop - HF
Mitral regurg - papillary m. regurg

Question 6

DDx of a STEMI

Answer 6

Pericarditis
Myocarditis
Stress induced CM (Takotsubo)
Early ventricular repolarization (esp. AA)

Question 7

What can increase troponin? (4)

Answer 7

Cardiac pathology

Pulm pathology (PE, pulm HTN, respiratory failure)

Renal pathology (RF, shock)

Neurogenic pathology (stroke, intracranial hemorrhage)

Question 8

How does white count change in a STEMI?

Answer 8

WBC ct. mildly increases

Question 9

BNP increases in:

Answer 9

HF, ventricular wall stress

Question 10

What test is used if a patient cannot exercise (in lieu of stress test)?

Answer 10

VD nuclear perfusion

Question 11

What test is used when a pt. is unable to tolerate VDs or exercise (in lieu of stress test)?

Answer 11

Dobutamine nuclear perfusion

Dobutamine echo

Question 12

Supply angina is caused by:

Answer 12

Decreased O2 delivery to tissue leading to ischemia

Question 13

Demand angina is caused by:

Answer 13

Increased myocardial O2 needs and workload leads to ischemia

Question 14

What is Levin sign?

Answer 14

A clenched fist in the substernal region seen in stable angina

Question 15

SX of Stable angina (6)

Answer 15

CP
Substernal pain
Pain brought on by exertion
Pain lasts for 5-15 min
Predictable frequency
ECG normal in 50% of pts.

Question 16

Acute coronary syndrome is which 2 pathologies?

Answer 16

UA

NSTEMI

Question 17

Cause of unstable angina

Answer 17

Plaque rupture or erosion leading to platelet aggregation and thrombus with partial artery occlusion

Question 18

SX of unstable angina (3)

Answer 18

New or worsening CP
Not predictable pattern of onset (may happen at rest)
Normal cardiac enzymes

Question 19

In unstable angina, if cardiac enzymes are elevated and ECG reveals ST depression or T wave inversion, what is the result?

Answer 19

NSTEMI myocardial necrosis

Question 20

What is the ECG criteria for a STEMI? (3 different ways)

Answer 20

ST elevation in 2 continuous limb leads or >2 mm ST elevation in 2 contiguous precordial leads or new LBBB

Question 21

STEMI pain is _______ than in angina.

Does NTG help?

Answer 21

Worse than in angina

NTG does not help

Question 22

3 ways to treat a STEMI

Answer 22

Send to cath lab
PCI - percutaneous coronary intervention
Fibrinolytic therapy - clot buster