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Cardiology Secrets > CHEST PAINS AND ANGINA > Flashcards

CHEST PAINS AND ANGINA Flashcards

1
Q

Do acute coronary syndromes account for most emergency room visits for chest pain?

A

No, they account for only a small percentage (1%–11%) of visits.

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2
Q

What are the life-threatening causes of chest pain that should be quickly recognized?

A

ACS, aortic dissection, pneumothorax, pulmonary embolism, esophageal rupture.

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3
Q

What is angina?

A

Discomfort associated with myocardial ischemia or MI due to oxygen demand exceeding supply.

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4
Q

Who first described angina and when?

A

William Heberden in 1772.

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5
Q

What are the characteristics of typical angina?

A
  • Substernal chest discomfort
  • Provoked by exertion or emotional stress
  • Relieved by rest or nitroglycerin
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6
Q

What is the difference between stable and unstable angina?

A

Stable occurs with increased demand; unstable occurs at rest or has a new onset.

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7
Q

What are the major risk factors for coronary artery disease?

A
  • Age over 45 for men, over 55 for women
  • Male gender
  • Family history of premature CAD
  • Hypercholesterolemia
  • Hypertension
  • Cigarette smoking
  • Diabetes mellitus
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8
Q

What symptoms may accompany angina?

A
  • Shortness of breath
  • Diaphoresis
  • Nausea
  • Fatigue
  • Radiating pains
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9
Q

What is the mortality rate increase associated with delayed diagnosis of aortic dissection?

A

Approximately 1% every hour from presentation to diagnosis and treatment.

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10
Q

What types of chest pain are less likely to indicate angina?

A
  • Stabbing pain
  • Pleuritic pain
  • Positional pain
  • Reproducible pain
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11
Q

True or False: The severity of chest pain is a strong predictor of angina.

A

False.

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12
Q

Fill in the blank: Angina can manifest as _______.

A

epigastric pain or discomfort.

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13
Q

What is the Levine sign?

A

When a patient clenches their fist over their chest while describing discomfort.

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14
Q

What duration of discomfort is typical for angina?

A

Minutes, not seconds or hours.

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15
Q

What describes the discomfort associated with myocardial ischemia or MI?

A

Angina.

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16
Q

What are the cardiovascular causes of chest pain?

A
  • Stable angina
  • Unstable angina
  • Acute MI
  • Aortic dissection
  • Pericarditis
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17
Q

What are the pulmonary causes of chest pain?

A
  • Pulmonary embolism
  • Pneumonia
  • Spontaneous pneumothorax
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18
Q

What are gastrointestinal causes of chest pain?

A
  • Esophageal reflux
  • Peptic ulcer
  • Gallbladder disease
  • Pancreatitis
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19
Q

What are the musculoskeletal causes of chest pain?

A
  • Costochondritis
  • Rib fractures
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20
Q

What is an ‘angina equivalent’?

A

Symptoms that manifest without classic chest discomfort, such as dyspnea.

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21
Q

What should be included in the differential diagnosis for chest pain?

A
  • Cardiovascular
  • Pulmonary
  • Gastrointestinal
  • Musculoskeletal
  • Psychiatric
  • Dermatologic
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22
Q

How do patients with aortic dissection typically describe their pain?

A

As tearing or ripping and radiating to the back

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23
Q

What is the Levine sign?

A

Occurs when the patient spontaneously clenches their fist over the chest while describing discomfort, indicating ischemic chest pain

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24
Q

What is the typical duration of stable anginal pain?

A

Approximately 2 to 10 minutes

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25
Q

What is the duration range for unstable anginal pain?

A

10 to 30 minutes

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26
Q

What activities can precipitate angina?

A

Exercise, mental stress, or anger

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27
Q

What typically relieves angina?

A

Sublingual nitroglycerin (SL NTG) or rest

28
Q

What does partial or complete relief with SL NTG within 2 to 5 minutes indicate?

A

More likely to be experiencing angina

29
Q

What are common associated symptoms that increase the likelihood of angina?

A
  • Shortness of breath
  • Diaphoresis
  • Nausea
  • Radiating pain
30
Q

What ECG abnormalities increase the likelihood of angina or acute coronary syndrome (ACS)?

A
  • ST-segment depressions
  • ST-segment elevations
  • T-wave inversions
31
Q

What does an elevated troponin level indicate?

A

Significantly increases the likelihood of angina and coronary artery disease (CAD)

32
Q

What physical exam findings suggest a cause other than angina?

A
  • Rub on auscultation
  • Difference in systolic blood pressure between arms
  • Systolic murmur at the right upper sternal border
  • Reproduction of pain with palpation
33
Q

What is the classic ECG finding in a patient with a large pulmonary embolism (PE)?

A

S1Q3T3 pattern (prominent S wave in lead I, Q wave in lead III, T-wave inversion in lead III)

34
Q

What is the initial workup for patients presenting with chest pain?

A
  • ECG
  • Chest X-ray
  • Cardiac biomarkers (troponin, CK, CK-MB)
35
Q

When should a stress test be obtained?

A

In patients with intermediate probability of having coronary artery disease (CAD)

36
Q

What is Prinzmetal angina?

A

An uncommon type of angina caused by coronary vasospasm

37
Q

What are common risk factors for Prinzmetal angina?

A
  • Smoking
  • Chronic alcohol use
  • Cocaine use
38
Q

When does Prinzmetal angina typically occur?

A

During rest, most commonly between midnight and 8 am

39
Q

What is cardiac syndrome X?

A

A condition characterized by anginal symptoms despite normal coronary arteries on angiography

40
Q

What is the primary treatment for Prinzmetal angina?

A
  • Calcium channel blockers
  • Nitrates
41
Q

True or False: Women often present with typical anginal symptoms.

A

False

42
Q

Fill in the blank: Pain that lasts continuously for a day or days is usually not ______.

A

angina

43
Q

What is a characteristic feature of the pain associated with myocardial infarction (MI)?

A

Described as pressure

44
Q

What finding on a chest X-ray can support the diagnosis of aortic dissection?

A

Widened mediastinum

45
Q

What is Prinzmetal angina?

A

A type of angina caused by coronary artery spasm, leading to chest pain.

46
Q

What are the first-line therapies for Prinzmetal angina?

A

Calcium channel blockers and nitrates.

47
Q

What is cardiac syndrome X?

A

A condition where patients have exertional anginal symptoms but nonobstructive epicardial CAD.

48
Q

What is another term for cardiac syndrome X?

A

Microvascular angina.

49
Q

What is the recommended initial treatment for microvascular angina?

A

Beta-blockers.

50
Q

What does an elevated troponin level indicate?

A

Possible myocardial necrosis but not definitive for acute coronary syndrome.

51
Q

True or False: Troponin elevation alone confirms the diagnosis of acute coronary syndrome.

A

False.

52
Q

What must accompany troponin elevation to support a diagnosis of acute coronary syndrome?

A

Angina or angina equivalent, ECG changes, and/or new wall motion abnormalities.

53
Q

What is the typical pattern of troponin levels in myocardial infarction?

A

Rise-and-fall pattern.

54
Q

List some conditions that can cause elevated troponin levels.

A
  • Sepsis
  • Hypotension
  • Severe hypoxia
  • Severe anemia
  • Severe hypertension
  • Tachyarrhythmias
  • Cocaine use
55
Q

What can cause troponin release during heart failure?

A

Myocardial strain.

56
Q

What condition associated with troponin elevation is linked to worse prognosis?

A

Pulmonary embolism (PE).

57
Q

What is myopericarditis?

A

Inflammation of the myocardium and pericardium causing elevated troponin levels.

58
Q

What can aortic dissection involving the RCA lead to?

A

Secondary myocardial infarction.

59
Q

How can chronic kidney disease affect troponin levels?

A

Troponins can be modestly chronically elevated.

60
Q

True or False: Elevated troponin levels can occur in acute stroke.

A

True.

61
Q

What is the risk associated with provocative testing for Prinzmetal angina?

A

Risk of coronary spasm refractory to NTG and other vasodilators.

62
Q

What are the potential outcomes of coronary spasm during provocative testing?

A
  • Prolonged ischemia
  • Myocardial infarction (MI)
  • Death
63
Q

What types of testing may show abnormalities in cardiac syndrome X?

A
  • ST-segment depressions
  • Perfusion defects
  • Wall motion abnormalities
64
Q

What role does microvascular coronary artery constriction play in cardiac syndrome X?

A

It is believed to contribute to the condition in some patients.

65
Q

What additional therapies can be considered for microvascular angina?

A
  • Calcium channel blockers
  • Nitrates
  • Ranolazine
66
Q

What is a common feature of elevated troponin levels in acutely ill, hospitalized patients?

A

Up to 45% are not due to coronary artery disease (CAD).

Cardiology Secrets (26 decks)

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