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EM quiz readings > Chest pain Quiz - Ch17 > Flashcards

Chest pain Quiz - Ch17 Flashcards

1
Q

What is classically described cardiac chest pain

A
  • retrosternal in the left anterior chest
  • radiation of pain to left shoulder, jaw, arm, or hand
  • associated sx of dyspnea, diaphoresis, nausea
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2
Q

what patients are at risk for having non-classic presentations of ACS

A
  • premenopausal and early menopausal women
  • racial minorities
  • DM
  • elderly
  • psych disease or AMS
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3
Q

what two specific things can accelerate atherosclerosis and therefore increases risk of ACS

A
  • HIV
  • cocaine

oddly specific idk why

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4
Q

what increases the likelihood that pain is due to an acute myocardial infarction (AMI)

A
  • radiation of pain to arms
  • worse w exertion
  • diaphoresis and N/V
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5
Q

How is the physical exam for ACS patients

A

often can be normal but you may see:
- tachycardia/bradycardia
- 3rd/4th heart sounds
- new murmur (rupture of cordae tendineae or Aortic root dissection)
- crackles in lungs (CHF)
- chest wall tenderness (15% of AMI pts)

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6
Q

how soon after arrival should chest pain patients receive an EKG

A

10 minutes

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7
Q

what EKG finding supports the dx of AMI

A

new ST segment elevations >/= 1mm in 2 contiguous leads.

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8
Q

what EKG findings support the diagnosis of ischemia and require further evaluation

A
  • new ST elevations (not 1mm not contiguous)
  • Q waves
  • LBBB
  • T wave inversion

(not enough to dx AMI but should be further evaluated)

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9
Q

why is a CXR useful in the dx of AMI

A
  • AMI cxr will be normal.
  • useful to r/o other dx such as thoracic aortic aneurysm, pna, or pneumothorax.
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10
Q

if you are suspecting pulmonary embolism or aortic dissection what imaging should be ordered

A

CT chest

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11
Q

which cardiac biomarker is the choice of detection for myocardial injury, why?

A

troponin (high sensitivity and nearly complete specificity)

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12
Q

How do you differentiate troponin that is elevated from an AMI vs troponin that is elevated from something such as CHF, PE, aortic dissection, ect.

A

based on the pattern of elevation.
in AMI, troponin elevates 2-6 hours after injury and may continue to elevate for up to 48 hours after injury.

they can stay elevated for up to 10 days.

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13
Q

what non cardiac disease can cause an elevated baseline troponin and should be taken into consideration when evaluating serial troponins

A

kidney failure.

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14
Q

what is the presentation for pulmonary embolism

A
  • sudden onset
  • pleuritic chest pain (worse w breahting)
  • dyspnea, tachypnea, tachycardia, hypoxemia
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15
Q

what imaging is used to identify pulmonary embolism

A

CT pulmonary angiography

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16
Q

what is the presentation for arotic dissection

A
  • sudden onset
  • severe tearing pain radiating to interscapular area of the back
  • unilateral pulse deficits (unequal pulses in arms)
  • could see focal neurologic deficits
17
Q

what are risk factors for aortic dissection

A
  • male
  • > 50
  • uncontrolled HTN
  • connective tissue disorder (marfans, ehlers-danlos)
  • cocaine use
  • valve replacement
  • pregnancy
18
Q

what is the workup for a suspected aortic dissection

A
  • CT aortogram or transesophageal echo
  • CXR (widened mediastinum)
  • D-dimer (sometimes elevated)
  • EKG (nonspecific ST seg or T wave changes)
19
Q

what is the presentation of esophageal rupture

A
  • sudden onset
  • sharp, substernal chest pain following an episode of forceful vomiting
  • ill appearing, tachycardic, febrile, with dyspnea and diaphoresis.
  • PE shows crepitus is the neck/chest from subcutaneous emphysema (audible crepitus is NOT usually found)
20
Q

what may be seen on a CXR of esophageal rupture

A

could be normal or may demonstrate pleural effusion, pneumothorax, pneumomediastinum, pneumoperitoneum, or subcutaneous air.

21
Q

what is the diagnostic study for esophageal rupture

A

CT chest with oral water soluble contrast.

22
Q

what is the presentation of spontaneous pneumothorax

A
  • sudden onset
  • sharp pleuritic chest pain with dyspnea
  • may see decreased breath sounds on affected side.
23
Q

what are risk factors for spontaneous pneumothorax

A
  • tall slender male patients
  • smoking
  • COPD
  • asthma
24
Q

what diagnostic studies are used to dx spontaneous pneumothorax

A

chest Xray showing collapsed lung

25
Q

what is the presentation of acute pericarditis

A
  • sharp, severe, constant retrosternal pain that radiates to back, neck or jaw
  • worse with supine, better with sitting forward
  • PE shows pericardial friction rub
26
Q

what is the diagnostics for acute pericarditis

A

diffuse ST segment elevations with PR segment depressions or T wave inversions.

27
Q

presentation of musculoskeletal causes of chest pain

A
  • sharp pain worsened w movement of the chest
  • completely reproducible pain with palpation and clear msk etiology
28
Q

GI causes

A

EM quiz readings (43 decks)

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