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CPR Exam 2 > Chest Pain DSAs > Flashcards

Chest Pain DSAs Flashcards

1
Q

If a patient presents with chest pain, what are 2 questions you should be sure to ask?

A
  1. Frequency
  2. Does it wake you up at night
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2
Q

Risk factors for CVD

Age:

___ is a major risk factor

Other: HTN, hyperlipidemia, smoking, sedentary/obestity, family Hx, stress, sleep disturbances

A

Men over 55 YO; Women over 65 YO

DM

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3
Q

What are the 7 SERIOUS potenially lethal causes of Chest Pain?

A
  • 1. M. ischemia
  • 2. MI (acute-AMI); STEMI/NSTEMI
  • 3. Aortic dissection
  • 4. PE
  • 5. Tension pneumothorax
  • 6. Esophageal rupture
  • 7. Pericarditis (effusion/tamponde)
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4
Q

PE findings associated with CV disease?

S4 gallop is heard _____

S3 gallop is heard _____

A
    1. Xanthema in eyes and elbows
    1. Nicotine stains on fingers, hair, odor
    1. Bruits (turbulent sounds)
    1. S4 gallop: angina
    1. S3 gallop: heart attack
    1. Mitral regurg, often due to dysfx of papillary muscle
    1. Diaphoresis
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5
Q

What can mimic angina in the absence of CAD?

A

1. Aortic insuff/ aortic stenosis/ Pulmonary HTN

2. Hypertrophic cardiomyopathy

3. Coronary spasm

4. HF

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6
Q

Differential dx of a STEMI?

A
    1. Pericarditis, myocarditis
    1. Stress induced Takotsubo cardiomyopathy (mimics ACS, LV apical balloning)
    1. Early ventricular repolarization in healthy patients, esp in AA
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7
Q

What can increase troponin level?

A
  1. Damage to myocardium
  2. Contusion, surgery, shock
  3. cardiomyopathies, HF
  4. Aortic dissection, AI, severe AS
  5. Tachycardia
  6. Pulmon: PE, pulm HTN, RF
  7. Renal: renal failure, shock
  8. Neurogenic: stroke or intracranial hemorrhage.
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8
Q

What will CBC show with STEMI?

A

mildly elevated WBC

- check troponin and CK-MB

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9
Q

CMP Panel shows what?

A

electrolytes, Mg, Ca, BUN, LFT

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10
Q

When are BNP levels increased?

A
  • HF
  • Stress to wall of ventricle d/t too much fluid
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11
Q

CRP may be ______ in STEMI?

A

increased

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12
Q

What is the initial stress test should we do if STEMI?

A
  1. Treadmill excercise

Then, stress echo to look at motion of wall, valve function and monitor cardiac rhythm.

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13
Q

When should pharmacologic stress testing be done w CP?

What are they?

A

When patient cannot excercise

  1. Vasodilator nuclear perfusion (via adenosine or regadenoson)
  2. Dobutamine nulcear perufsion (if cannot tolerate vasodilator or excercise)
  3. Dobutamin echo
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14
Q

What imaging should be done when a patient has chest pain?

A
    1. CXR
    1. Echo
    1. Cardiac MRI to look at thickness of wall and size of chambers.
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15
Q

Supply angina is caused by what?

A

Decrease in O2 supply to the heart due stenosis, vasoconstriction, causing platelets to release 5HT and TXA2 => platelet aggregation

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16
Q

Demand angina is caused by what?

A

<3 needs more O2 due increased workload => ischemia

  • stress, excerise, fever, thyrotoxicosis, LVH due to AS, anemia
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17
Q

What are symptoms of stable angina?

Pattern of pain?

A
  • Chest pain on exertion, emotion, stress that lasts 5-15 minutes and is relieved by rest of nitro.
  • Does not change in freq, duration or intensite
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18
Q

What does a patient with stable angina show on ECG?

A
  • 50% have NL ECG
  • -ST depression/ST elevation
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19
Q

What is a unstable angina?

A
  • ACS (acute coronary syndrome) that causes CP due to rupture of a atherosclerptic plaque => platelet aggregation and thrombus formation that partially occludes the artery.
  • Increase frequency, severity, lasts longer than 15-20 minutes that occurs at rest/less effort.
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20
Q

NSTEMI myocardial infarction (NSTEMI) is distinguished from unstable angina by…

A

NSTEMI will have:

  1. High levels of cardiac enzymes (troponin/CKMB)
  2. Biomarkers of myocyte necrosis
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21
Q

What does NSTEMI look like on ECG?

A
  • ST depression
  • T wave inversion
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22
Q

How do we treat stable angina?

A
  • 1. Low sat/trans fat diet, low Na+ diet, lose weight
    1. Nitroglycerin as needed for CP; 1 sublingual tab/5min; do not take 3 in a row.
    1. Long acting nitrates, B-blocker, CCB for coronary spasm, aspin, ACE-I
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23
Q

How do we treat ACS (unstable angina/NSTEMI)?

A
  1. Nitroglycerin, B-blocker, ASA, statin
  2. ACE-I
  3. Platlet ANT/aNTi-coag
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24
Q

What is a STEMI?

A
  • ST-elevated MI: Thrombus formed by erosion, fissure or rupture of plaque that completely interupts flow to heart (transmural)
  • D/t; atherosclerosis**, coronary spasm, vasculitis, dissection
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25
Q

What is the ECG criteria for a STEMI?

A
  • ST elevation in 2 continguous limb leads
  • or
  • 2 mm ST elevations in 2 continous precordial leads or new LBBB
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26
Q

Describe the pain in a STEMI?

A
  • More severe than angina and cannot be relieved by NTG or rest
  • substernal => neck/jaw => left arm
  • N/V, SOB, sweating
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27
Q

Are all STEMIs painful?

A

20% are painless, esp in elderly female with DB

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28
Q

How do we treat STEMI?

A
    1. Hospital + cardiac catheterization
    1. PCI (percutaneous coronary intervention) or fibrinolytic therapy (clot buster)
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29
Q

Valvular heart disease most commonly are due to what?

A

Senile calcification/degeneration.

Other: myxocmatous degernation (MVP) or congenital (BAV)

30
Q

Murmurs are a result of what?

A
    1. Tubulence across valve
    1. Increase blood flow (anemia/pregnancy)
31
Q

Stenosis creates ____ overload, causing what?

A
  • Pressure overload
  • Hypertrophy and HF
32
Q

Regurg creates ____ overload, causing what?

A

VOLUME

Dilates heart

33
Q

List the 5 valvular causes of systolic murmurs

A

MR P.V. TRAPSS

  • Mitral regurg/prolopase
  • VSD/ASD
  • Triscupid regurg
  • Aortic stenosis
  • Pulmononis stenosis

last s = stenosis

34
Q

List the 4 valvular causes of DIASTOLIC murmurs

A

MSTS PAID “mistess paid”

  1. Mitral stenosis
  2. Tricuspid stenosis
  3. Pulmonary insuf/regurg
  4. Aortic insuf/regurg

Diastolic

35
Q

Murmur grade scale (1-6)

A
  1. Barely audible
  2. Soft/faint
  3. Louder, easily heard
  4. Very loud + palpable thrill (vibration)
  5. Heard with stethoscope barely touch chest + thrill
  6. Can hear w/o steoth or close to chest + thrill
36
Q

pt comes in and murmur is very loud with palpable thrill.

what grade

A

4

37
Q

What are the 2 etiologies of chronic mitral regurgitation (MR) and which is most common?

A
  1. Mitral valve prolapse = MOST common-
  2. Myxomatous/ degeneration or mitral annular calcification (MAC)
38
Q

What are 4 causes of acute mitral valve regurgitation?

Which is 2nd most common cause of MRregurg?

A
    • Rupture of chordae tendineae
    • Rupture of papillary muscle
    • Ischemic papillary muscle dysf. due to CAD/MI
      1. 2nd most common cause
    • Infective endocarditis(IE); valve perforation
39
Q

Systolic murmur (blowing, holocystolic) that is best heard at apex => radiates to L axilla

A

Mitral regurg

40
Q

What is MVP?

A

1 or both leaflets prolapse into atrium d/t myxedematous degeneration

41
Q

Which sex is most often affected by mitral valve prolapse (MVP) and what are congenital defects which increase risk?

A
  • Women 7:1
  • Assoc. with Marfans/skeletal changes
42
Q

What are the range of sx’s/signs associated with MVP?

A
  • Asymptomatic to [arrhythmias (SVT, PVC’s, VT), chest pain and/or syncope]
43
Q

F pt presents to office with hx of palpitations, dizziness, scared of habing a heart attack.

what kind of murmur is thought to be there

A

MVP

44
Q

What is the characteristics of the murmur heard with MVP?

A

Systolic murmur heard best at the apex that may have a systolic click

will incrrease with valsalva and standing

45
Q

Systolic murmur heard best at the apex that may have a systolic click

will incrrease with valsalva and standing

A

MVP

46
Q

If patient with MVP is in hyper-adrenergic state (anxious, palpitations), consider using what drug class?

A

Beta-blocker

47
Q

What are 3 causes of Aortic Stenosis and which is most common?

A

- Most common = Degeneration calcification of valve (—> persons >65 yo

  • Congenital or acquired bicuspid aortic valve (BAV)
  • Rheumatic/post-inflammatory scarring (radiation)
48
Q

Which decade does aortic stenosis typically manifest in and what are the 4 cardinal signs/sx’s?

A
  1. - 6th decade
  2. - Exertional dyspnea
  3. - Angina
  4. - Syncope
49
Q

The obstruction in aortic stenosis leads to what type of overload (pressure/volume) and what are the downstream effects?

A

PRESSURE overload –> LVH –> ↑ pressure= diastolic dysf + systolic HF

50
Q

What are the common PE findings of aortic stenosis (i.e., pulse pressure, SV and systolic pressure)?

A
  • NARROW pulse pressure
  • Decreased SV and systolic pressure
  • Delayed pulses --> Parvis (weak w/ ↓ amplitude) or Tardus (late/delayed)
51
Q

What are the characteristis of the murmur heard in aortic stenosis (heard best where, radiates)?

Affect on S2 sound?

A
  • Systolic murmur (crescendo-decrescendo) that is harsh at 2nd ICS at RSB => radiates to sternal notch and carotics
  • Decreased S2
52
Q

What will we see on ECG with aortic stenosis?

A

LVH and strain pattern (down-sloping of ST segment - Twave)

53
Q

BAV is associated with what diseases?

A

Marfans

Turners

54
Q

where is pulmonic stenosis heart at?

A

Sytolic murmur (crescendo-decrescendo) heart best at the 2-3 ICS at the LSB => radiates to left shoulder/clavicle.

55
Q

Pulmonic stenosis may be assx with what?

A

Tetralogy of fallot: PS, VSD, RVH and overriding aorta

56
Q

What dose a VSD murmur sound like?

A

Holosytolic murmur heard best at the lower left sternal border with thrill.

L-> R shunt Increases with handgrip

57
Q

What dose a ASD murmur sound like?

A
  • Systolic murmur at the upper LSB with fixed splitting of S2
    • L => R shunt
58
Q
  • Mitral/ tricuspid stenosis
  • Aortic/pulmonic regurg

The narrowing of the mitral orifice seen in MS, leads to an increased pressure gradient where and what other changes?

A
  • ↑ left AV pressure gradient
  • LA enlargment –> afib, pulmonary vascular changes, RVH
59
Q

Most common presenting sx’s of someone with mitral stenosis (MS)?

A
  • Fatigue d/t. decreased CO
  • Dyspnea on exertion, cough, orthopnea, PND, pulmonary edema, hemoptysis
60
Q

What is Ortner syndrome associated with MS?

A

Hoarsness due to compression of left recurrent laryngeal n. as LA ↑ in size

61
Q

Describe the murmur associated with MS (i.e., phase of cardiac cycle, best heard where/position and with what part of stethoscope)?

A
  • DIASTOLIC, low pitch, decrescendo, rumbling murmur
  • Best heard at APEX w/ pt in left lateral decubitus position
  • Use BELL
62
Q

What are the ausculatory findings of S1 and S2 in pt with MS?

A

↑ loud S1 + ↑ S2 (P2 if PHT is present)

  • Opening snap after S2 (if leaflet is mobile)
63
Q

Common EKG finding of someone presenting with sx’s of severe MS?

A

Atrial fibrillation

64
Q

If person with mitral stenosis is in sinus rhythm, they will have _____

A

Left atrial enlargement

  • *‘M’ shaped ‘p’ wave = P mitrale
65
Q

What type of murmur is associated with Tricuspid Stenosis and where is it best heard?

What causes an increase and decrease in the murmur?

A
  • DIASTOLIC, LOW pitch, decrescendo murmur at LSB
    • Increase w/ inspiration (Carvallo’s sign)
    • Decrease w/ expiration and valsalva
66
Q

Which wave in JVP is Tricuspid Stenosis vs. Regurgitation associated with?

A
  • TS = prominent “A” wave in JVP
  • TR = V wave in JVP
67
Q

What will we see on ECG with Tricuspid stenosis?

A

Right atrial enlargement

68
Q

Most causes of pulmonic regurgitation (PR or PI) are due to what?

A

Pulmonary HTN

69
Q

What is the characteristic murmur heard with Pulmonic Regurgitation and heard best where?

A

DIASTOLIC, decrescendo blowing murmur at 2nd ICS LSB = Graham Steell

70
Q

There will be an increased P2 if pulmonic regurgitation is due to what?

A

Pulmonary HTN

CPR Exam 2 (29 decks)

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