Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Path II > Chest Pain, Heart And Lungs > Flashcards

Chest Pain, Heart And Lungs Flashcards

1
Q

What is the incidence of chest pain or cardiorespiratory symptoms in the chiropractic setting?

A

In teaching clinics - 1-7%
Chest complaints - 3.8%
Heart murmur = rare
Angina or MI = rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

__% of chest pain patients in the ER will have acute coronary syndrome (heart attack or unstable angina)

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

__% of patient with symptoms of acute cardiac ischemia will prove to have an MI

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

__% of chest pain patients in a primary care medical office have unstable heart disease (emergency referral)

A

1.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Draw out the classification table of acute chest pain

A

(Pic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the most common causes of chest pain in patients who seek care in primary care office?

A

MSK conditions = 29-36%
Gastrointestinal disease = 10-19%
Stable CAD = 8-10%
Psychosocial or psychiatric disease = 8-17%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A patient with chest pain who shows signs of respiratory distress or whose vital signs are abnormal (e.g., low Bp, weak or irregular pulse) may have an acutely unstable heart problem.

A

Call an ambulance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Can you differentiate CHD from GERD or chest wall syndrome based on location?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are three ways to investigate the heart?

A
  • Blood pressure
  • Pulse
  • Auscultate heart (listen to mitral valve while patient does Valsalva)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are two ways to investigate the upper GI track

A
  • Palpate/percussion upper quadrants (knees flexed)

- carefully include epigastric region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are three ways to investigate the spine and body wall?

A
  • Static and motion palpation of cervical, thoracic spine (include TLJ)
  • palpate The ribs and back muscles
  • Palpate The chest wall (include costosternal junctions, pectoralis, intercostals).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 5 ways to investigate the lungs?

A
  • Observe respiratory rate
  • Observe breathing, use of accessory muscles
  • Palpate for fremitus
  • Percuss
  • Auscultate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some ways a heart attack can present?

A
  • chest pain
  • shortness of breath
  • dizziness, weakness, syncope
  • abdominal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Of those who die from a heart attack, most die within ___ hours of symptoms onset

A

The first two

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are 4 high risks for acute coronary syndrome?

A
  • Chest pain which is exertional,
  • Pain radiating to one or both arms,
  • Pain similar > prior cardiac chest pain
  • Or associated with nausea, vomiting, or diaphoresis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are low risks (4) for acute coronary syndrome, making it less likely? What are somewhat lower risks (2)?

A
  • Pain is pleuritic (related to breath cycle)
  • Pain is positional
  • pain is reproducable with palpation (BEST CLUE)
  • quality of pain is stabbing (if they can point to the location with one finger)

somewhat lower risks

  • pain is not exertional
  • pain in small inframammary area of chest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where is the location for acute coronary syndrome?

A
  • C3-T10
  • down one or both arms
  • in the middle of the shoulder blades
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CLINICAL PEARL

Suspect cardiac angina in any patient who describes any discomfort above the waist that . . .

A

Is provoked by exercise and relieved by rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are associated symptoms questions to ask about chest pain?

A
  • dyspnea
  • dizziness
  • diaphoresis
  • nausea
  • weakness/fatigue
  • (near) syncope
  • palpitations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are modifiable risk factors for CVD? What is the prevalence of each?

Can these be used to rule out heart disease?

A
  • Overweight or obese – 65%
  • LDL cholesterol >130 mg/dL – 46%
  • Physically inactive – 38%
  • HDL cholesterol 40 mg/dL – 26%
  • Hypertension – 25%
  • Tobacco use – 25%
  • Metabolic syndrome – 24%
  • PREHYPERTENSION – 22%
  • DIABETES MELLITUS – 8%

NO, Ex: 22% have hypertension but 78% do not so it’s absence does not rule out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are non-modifiable risk factors for acute coronary syndrome?

A
  • Male gender
  • Family history
  • Increased hsCRP (they are pro-inflammatory) (somewhat modifiable)
  • HRT hormone replacement therapy (?)
  • Increased coronary artery calcium
22
Q

Describe what the test for increased coronary artery calcium is?

A

Not a blood test, it’s a specialized CT scan

23
Q

What are ancillary studies for CAD RISK factors?

A
  • Lipid profile
  • Glucose/Hgb A1C/ 2 hour post load
  • hsCRP
  • Coronary artery calcium (CAC) (This is a CAT, Ancillary studies for CAD risk factors not a blood test)
24
Q

What separates stable angina from a heart attack?

A

Brief ischemic episode without permanent heart damage

*no cardiac enzyme released into the blood

25
Q

How do you diagnose angina? Atypical angina? Non cardiac chest pain?

A

Typical angina (definite)

  1. Substernal chest discomfort with a characteristic quality and duration
  2. Provoked by exertion or emotional stress
  3. Relieved by rest or nitroglycerin
Atypical angina (probable)
Meets 2 of the above criteria

Noncardiac chest pain
Meets 1 or none of the above.

26
Q

What are ancillary studies for suspected angina?

A
  • 12 lead resting EKG (often normal; positive cannot confirm angina)
  • Tests of choice: stress tests (EKG, echo,
    myocardial perfusion scintigraphy). New: coronary computed tomography angiography (CCTA) & cardiac MRI
  • Chest radiograph (optional)
  • Risk factor tests
  • Angiography (gold standard)
27
Q

How is a 12 lead resting EKG performed?

A

?

28
Q

How is a stress EKG performed?

A

Hooked up to 12 leads while on a treadmill

29
Q

How is a echo stress test performed?

A

Put on treadmill to get heart rate up

Immediately followed by Ultrasound over patients chest to visualize heart

30
Q

How is a myocardial perfusion scintrigraphy performed?

A
  • A dye is injected that accumulates in the heart
  • Patient undergoes stress and then is scanned
  • If there is an area without accumulated dye, there is a blockage there
31
Q

What is the gold standard test for suspected angina?

A

Angiogram - needle inserted and injects dye into heart

32
Q

What are three ischemic heart issues?

A

Stable angina, unstable angina, MI

33
Q

If your patient as angina but it seems stable, what should you do?

A

Still treat it as unstable and have them go to their PCP today or tomorrow?????

34
Q

What two dx make up acute coronary syndrome?

A

Acute MI

Unstable angina

35
Q

What are signs for stable angina? (6)

A
  • exertion related
  • usually <10 min
  • rest & nitro help
  • ST depression on EKG
  • negative enzymes
  • due to athero
36
Q

What are the signs of unstable & prinzmetal angina? (6)

A
  • occurs at rest
  • > 10 min
  • nitro usually helps
  • ST depression or elevation
  • unstable due to complicated athero
  • prinzmetal due to vasospasm
37
Q

What are the top three clues from history that increase the probability of acute MI?

A
  • nausea (+LR 10)
  • both arms with pain (+LR 9.7)
  • right arm pain (+LR 7.3)

*don’t memorize exact +LR #

38
Q

Wen should you be more worried about heart disease based on history

A

If the patient stopped activity

39
Q

What are physical exam findings of heart attack?

A
  • third heart sound
  • hypotension(SBP =80 mm Hg)
  • pulmonary crackles
  • diaphoresis
40
Q

What are physical exam findings that DECREASE the probability of acute MI?

A
  • pleuritic chest pain
  • chest pain is sharp or stabbing
  • positional chest pain
  • chest pain reproduced with palpation
41
Q

What makes you more suspicious of MI based on the Marburg Heart Score?

A
  • women >64, men >54
  • known CAD, cerebrovascular disease, or peripheral vascular disease
  • pain worse with exercise
  • pain not reproducible with palpation
  • patient assumes pain is cardiac
42
Q

What are ancillary studies for MI?

A
  • 12 lead EKG (+LR 22, -LR 0.2) (still can’t rule out)
  • troponins (a break down particle released from heart)
  • cardiac enzymes (CPK-MB, AST)
43
Q

What is the pattern of troponins and cardiac enzymes (CPK-MB, AST) after MI?

A

they raise after MI, peak around 12 hours, then are gone by around 24 hours

44
Q

What are causes of chest pain? What are the big clues? What is the ancillary study?

A

Mitral valve prolapse

  • BIG CLUE: hear a mid-systolic murmur or closing click (luv-swish-dub or click-dub)
  • ancillary study: echocardiogram

Pericarditis
-BIG CLUE:
1 - non-pleuritic friction rub (sounds like when you grind your hair together) (have them hold their breath to ensure it’s heart and not lung)
2 - pre-cordial pain radiates to trapezius ridge
3***- aggravated by supine, relieved to bending forward
4 - with characteristic ECG changes

PLEURITIS

  • BIG CLUES: pleuritic pain (worse with a deep breath/ timed with the breath cycle), Respiratory friction rub, may have fever/ malaise, follows pneumonia???, follows SLE????
  • ancillary study: chest radiograph, CBC, blood chemistry, ESR

GERD
- ancillary studies: acid-suppression test

Gallbladder, duodenal ulcer
- palpate upper quadrants

Anxiety
- questionnaire

MFTP

Thoracic spine subluxation

45
Q

How do you do perform an acid suppression test for GERD?

A

2 weeks, 40mg 2x/day, if it takes away chest pain it is GERD

46
Q

What is the general screening test for SLE?

A

Ana = anti-nuclear antibody

47
Q

What are the three questions for a panic disorder?

A
  • when you are nervous, how often do you think, “I am going to pass out”?
  • during the last 7 days, including today, hw much have you been bothered by pain in the chest?
  • to what degree is your chest pain tiring or exhausting?
  • 76% of patients with a score <4 will not have panic disorder and 71% of patients with a score of >5 will have panic disorder
48
Q

What do you need to palpate when investigating musculoskeletal causes of chest pain?

A

?

49
Q

What muscles may have MFTP’s? Where do they refer?

A
  • Scalene
  • pec major
  • pec minor
  • serratus anterior
50
Q

How do examine muscular causes of chest pain?

A

Palpate, contract, stretch

Clin Path II (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions