Chest Pain (Johnson) Flashcards

1
Q

What are some non-cardiac causes of chest-pain?

A
GERD
Acute cholecystitis
Esophageal motility disorders
PE, pneumothroax, pneumonia
Lung cancer
Cervical/thoracic spine
Chest wall strain or trauma
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2
Q

What are some lab tests that might be abnormal due to a STEMI?

A

CBC: elevated WBC, troponin I, and CKMB
BNP: elevated

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3
Q

What can mimic angina in the absence of CAD?

A
Aortic insufficiency, aortic stenosis 
Pulmonary HTN
Hypertrophic cardiomyopathy
Heart failure
Coronary spasm
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4
Q

What are the ‘serious seven’ potentially lethal causes of chest pain?

A
Myocardial ischemia
MI
Aortic dissection
PE
Pneumothorax
Esophageal rupture 
Pericarditis– pericardial effusion/tamponade
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5
Q

When do we usually hear an S4 gallop? What about an S3 gallop?

A

S4: angina
S3: heart failure

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6
Q

Are cardiac enzymes elevated in an unstable angina?

A

No– if cardiac enzyme are elevated and EKG reveals ST depression/T-wave inversion this is a NSTEMI

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7
Q

What would be included in a ddx of a STEMI?

A

Pericarditis, myocarditis
Stress induced cardiomyopathy
Early ventricular repolarization

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8
Q

What supplies the inferior wall?

What might an occlusion here cause?

A

RCA– an occlusion here might cause a mitral regurgitation murmur due to papillary muscle dysfunction

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9
Q

How do we tx an unstable STEMI?

A

NTG, B-blocker, ASA, statin
Consider ACEi
Platelet antagonist

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10
Q

What are some physical exam findings associated with CVD? (6)

A
Xanthelasma
Nicotine stains and odors
Bruits
S4 and S3 gallops
Mitral regurgitation
Diaphoresis
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11
Q

What pathology might be elevated by chest pain that feels better when leaning over?

A

Pericarditis

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12
Q

How is stress testing performed after a suspected STEMI?

A

Treadmills exercise test is the initial test if available with stress echocardiogram. When exercise is not tolerable, pharmacological testing is done instead– vasodilator nuclear perfusion > dobutamine nuclear perfusion > dobutamine echocardiogram

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13
Q

What is the most common pathogenesis of mitral regurgitation?

A

Papillary muscle dysfunction

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14
Q

How do we tx a stable angina?

A
Lifestyle modifications
NTG for chest pain (every 5 min x 3)
Long acting nitrates
B-blocker
CCB
Statin
Aspirin
ACEi if EF<40%
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15
Q

What are some non-chest pain sx of IHD?

A
Dyspnea
Excessive fatigue/weakness
Dizziness/syncope
Nausea/indigestion/heartburn
Neck-jaw pain
Diaphoresis
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