Chest Pain in the ED Lecture Powerpoint Flashcards
Most common noncardiac cause of chest pain
GERD
In the ER, what 3 causes of chest pain are most likely to be seen
- Coronary artery disease
- Pulmonary (pneumonia, bronchitis, asthma)
- Psychiatric (anxiety, depression)
3 diseases within acute coronary syndrome
-Unstable angina (impending MI, no myocardial damage yet)
-STEMI
-NSTEMI
(both cases cardiac biomarkers are elevated)
Most common life threatening conditions resulting in chest pain (6)
- Acute coronary syndrome
- Cardiac tamponade with pericarditis (rare)
- aortic dissection (ripping tearing pain radiating to back)
- pulmonary embolus
- tension pneumothorax
- esophageal rupture/boorhave syndrome (thru violent vomiting or retching
Beck’s triad for cardiac tamponade
- hypotension
- muffled heart
- JVD
Aortic dissection definition, diagnosis (2), treatment (3)
- Breaking in integrity of aortic wall, often background history of marfan syndrome or hypertension, symptoms include sharp ripping shearing pain radiating to back, may have weak or absent peripheral pulses or new murmur of aortic insufficiency
- CT with contrast or Transesophageal echocardiogram
- IV labetalol or IV nitroglycerin followed by surgical approach
Pulmonary embolism definition, diagnosis (2), treatment (2)
Commonly occurs after surgery or immobilization, pain often pleuritic and described as crushing, shooting, accompanied by dyspnea, signs can include tachycardia, tachypnea, hemoptysis, hypoxemia, EKG may show sinus tach (most commonly)*** and S1Q3T3 right heart strain pattern (15%)
- D dimer highly sensitive, CT of chest is diagnostic
- anticoagulation, emboleectomy if large
Tension pneumothorax definition and treatment options (2)
Collapsed lung with air or gas trapped and allowed to move in but not out resulting in shifting of mediastinum away from affected lung compressing heart and decreasing cardiac output, sharp pleuritic chest pain with associated dyspnea, decreased or absent breath sounds, tracheal deviiation, tachycardia, tachypnea, hypotension, cyanosis, subcutaneous emphysema, JVD
-Chest tube, needle thoracotomy
Diagnostic gold standard study of choice after CXR, EKG, enzymes for CAD is….
….cardiac catheterization
Classic clinical presentation of angina (5)
- exertionally worsened
- relieved by rest or nitroglycerine
- described as substernal pressure, squeezing, burning
- can radiate to left arm, back, neck, or jaw
- associated with dyspnea
Exertional chest pain is ___ until proven otherwise
angina
Stable vs unstable angina
Results from gradual plaque enlargement and is predictable in frequency and severity vs unstable results form plaque rupture causing chest pain with minimal exertion or at rest and is new onset or accelerated symptoms of previously stable angina
Leads II, III, and AVF correspond to ___ wall of heart corresponding to ___ coronary artery
Leads I, AVL, V5 and V6 correspond to ____ wall of the heart, leads V1, V2, V3, V4 correspond to the ___ wall
Inferior, right, lateral, anterioseptal wall
Ischemic other cardiovascular causes of chest pain (6)
- coronary vasospasm (prinzmetal angina)
- hypertrophic cardiomyopathy
- severe pulmonary hypertension
- aortic insufficiency/mitral regurg
- severe anemia
- cocaine use
Pericarditis definition and EKG finding (1)
- Inflammation of the pericardial sac most often viral in origin but can also be due to malignancy, end stage renal disease, dresslers (post MI), sees sharp crushing substernal with pleuritic component, aggravated by supine position, may hear friction rub
- sees diffuse ST segment elevation on EKG
Most common cause of musculoskeletal chest pain, how is it reproducable?
-costochondritis (reproducable with palpation of costochondral or costosternal junctions)
S3 represents ___ dysfunciton, S4 represents ___ dysfunction
Systolic, diastolic
Diagnostic studies for chest pain patients (7)
- EKG
- CXR
- Cardiac enzymes, LFTs, amylase/lipase, D dimer, CBC
- stress testing
- echocardiogram
- cardiac catheterization (coronary angiography)
- CT/VQ
The only reason to perform an echocardiogram in pericarditis is to…
….assess for effusion and impending tamponade
Pericarditis is worse in what position?
Supine
Most constant cardiac pain does not last more than….
….24 hours
