chest pain pearls

Question 1

chest pain/

esophagitis/causes

Answer 1

reflux

rx-related

Question 2

framework for dx of chest pain/

out to in

Answer 2

skin=>breast=>msk=> sk=sternum=> mediastinal structures

Question 3

framework for chest pain/

up to down

Answer 3

up: _esophageal;GI;
out: _pulmonary;

out _cardiac;vascular

up:PSYCH!=_panic attack!

Question 4

chest pain/

skin/diff

Answer 4

_Herpes zo_ster

Question 5

chest pain/

breast/diff

Answer 5

_Fibro^adenomas/

_Mastitis/

_Gynec^omastia

Question 6

chest pain/

Msk/diff (6)

Answer 6

in cartilage:

_Costoc^hondritis

_Precordial catch ^syndrome /

muscle:

_Pectoral muscle ^strain/

_Myo^sitis

bones _Rib fracture

Cervical or thoracic _spondylosis (C4–T6)

Question 7

chest pain/

esophageal/diff dx

Answer 7

_Spasm

Rup^ture

_Esophag^itis

a. _Reflux
b. _rx-related

_Neoplasm

Question 8

chest pain/

GI/ diff

Answer 8

_Peptic ulcer ^disease

_Gallbladder ^disease

_Liver abs^cess

_SubDiaph^{ragmatic abscess}

_Pancrea^titis

Question 9

chest pain/

pulmonary/pleural/ diff

Answer 9

fluid

Pleural ^effusion

Pneumo^thorax

Infection:Pneum^onia

_Viral infections

_Neoplasm

Question 10

chest pain/

pulmonary/lung/ diff

Answer 10

infection: Pneu^monia

Neo^plasm

Question 11

chest pain/

pulmonary/plmonary vasculature/ diff

Answer 11

P^E

_Pulmonary ^HTN

Question 12

chest pain/

cardiac/ diff

Answer 12

_Pericard^itis

_Myocar^ditis

_Myocardial isc^hemia (stable + unstable angina; MI)

Question 13

chest pain/

vascular/ diff

Answer 13

^Thoracic aortic aneu_rysm

_aortic dissec^tion

Question 14

chest pain/

mediastinal structures/ diff

Answer 14

^Lympho_ma

_Thymo^ma

Question 15

causes of angina other than CAD?

5

Answer 15

^{blood: Ane}mia

pump: Tachyc^ardia of any cause

atrial fibr^illation;

^hyperthyroidism)/

_Hypertrophic cardio^myopathy

Heart _failure (HF)

^{tube= vascular Aorti}c stenosis

Question 16

traditional cardiac risk factors of CAD

to ask to pt w chest pain

Answer 16

Male sex

age= > 55 years in men and > 65 years in women

_DM , H^TN

FHx of _premature ^CVD (> 55 years in men and > 65 years in women)/

smo^king

lab: _Abnormal li^pid profile

Question 17

chest pain: ok to prescribe an empiric course of PPI proton-pump inhibitors;

when must-not-miss dx have been excluded?

Answer 17

yes;

bec G^ERD =common cause of chest pain

Question 18

Pt with chest pain/

what to do w/in 10 ^min of their presentation

Answer 18

have an E^CG

Question 19

chest pain/

taking hx/ what to do?

Answer 19

Use the patient’s _own ^words

Question 20

pt w chest pain

+ 1-mm ST elevations=

up in 2 contiguous leads or

a new LBBB left bundle branch block

is having….?

what to do next?

Answer 20

acute ^MI

give i_mmediate ther^apy.

Question 21

women w chest pain

who actually have a MI

have what sx?

Answer 21

_<50% do N_OT have chest pain

Question 22

Vasos^pastic ang_ina/

considered in which pt

Answer 22

pts whose sx are consistent with ^cardiac isch^emia +

occ at about the same ^time each _day.

ECG w ^transient _ST elev^ations: consider Vasospastic angina

/ hint:VA = veteran celebrate end of war every year

Question 23

_{<strong>young </strong>}+hype^rtensive patient w

CC= ^chest pain after using co^caine;

consider…

Answer 23

_{heart: M}I

BV: thor^acic a^ortic dissec_tion

Question 24

dissection of the thoracic aorta/

chest film ;

what can u see?

Answer 24

aorta is n_ormal!!

on the chest film in about _40% of cases

Question 25

what to do when **pleural effusion** is found?

Answer 25

***eval^uate*** any NEW pleural effusion!!/ pleural effusion is NOT nl

Question 26

Pleural fluid testing/ include?

Answer 26

***L^D*** (exudate vs transudate); **pro_tein** (exudate); **^albumin**; **pH**; **cell ^count**+ **cyto_logy** (viral; bacterial)

Question 27

chest pain and ***no clear*** dx/ what imaging to do?

Answer 27

***che^st fil_m***

Question 28

how to distinguish pericarditis vs MI?

Answer 28

presence of a **r^ub** + analysis of the ***E_CG***