chet pain and palpitations

Question 1

life threatening causes of chest pain

Answer 1

acute coronary syndrome
pulmonary embolism
thoracic aortic dissection
tension pneumothorax
oeseophageal rupture

Question 2

signs and symptoms of life threatening cause of chest pain

Answer 2

dyspnoea, syncope/presyncope
palpitations, diaphoresis, nausea, vomiting
hypoxaemia, hypotension, cyanosis,
tachycardia or bradycardia

Question 3

findings on exam that may suggest specific pathologies

Answer 3

pulsse deficits and/or differences in blood pressure in right and left arm suggests possible thoracic aortic dissection
hypoxia, tachypnoea, tachycardia suggests sspontaneous pneumothorax
pericardial firction rub suggests acute pericarditis
chest pain reproducible with palpation suggests musculoskeletal chest wall pain

Question 4

differences in blood pressure between right and left arms suggests

Answer 4

possible thoracic aortic dissection

Question 5

pericardial fraction rub suggests

Answer 5

acute pericarditis

Question 6

for patients with suspected acute coronary syndromes

Answer 6

ECG
tropinin I or T at presentation - repeat at 12 hours

Question 7

indications for CXR

Answer 7

suspected pneumonia
usually normal in patients with PE and uncomplicated ACS
usually abnormal in patients with thoracic aortic dissection and spontenous pneomothorax

Question 8

echocardiography

Answer 8

consider to differentiate between acute coronary syndrome and acute pericarditis
may detect regional wall motion abnormalities, acute pericarditis, valvular heartdisease, thoracic aortic dissection, pulmonary embolism, pneural effusion

Question 9

CT

Answer 9

for patients with suspect PE and/or abnormal d dimer assay

Question 10

treatment for suspected acute coronarry syndrome

Answer 10

give aspirin
sublingual nitroglycerin.
acute coronary syndrome Rx

Question 11

treatment for patients with suspected aaortic thoracic dissection

Answer 11

sudden onset severe chest and back pain and pulse deficits on physical exam
refer to surgery

Question 12

treatment for patients with acute periciarditis

Answer 12

pleuritis chest pain that i worse is supine position, fever and pericardial friction rub

Question 13

for patients with ssuspected GORD

Answer 13

empiric trial of PPIs

Question 14

pain characteristics suggestive of musculoskeletal abnormality

Answer 14

pain precipitated by exercise
pain at the left side of the chest may be radiating pain from carpel tunnel syndrome
localissed tendernes

Question 15

evaluation of palpitations

Answer 15

ECG and physical exam
bloods - thyroid stimulaating homrone to detect hyperthyroidism
urea, creatinine and electrolytes to detect renal impairment or electrolyte abnormalities
dypsnea, syncope or chest pain indicates cardiac eaitiology

Question 16

24 hour halter monitor

Answer 16

may be appropriate for patients with daily symptoms

Question 17

external event record

Answer 17

7-28 days
patients record at push of a button

Question 18

implantable loop recorders

Answer 18

up to 3 years monitoring duration

Question 19

how to decide if you should anticoagulate an AFib patient

Answer 19

HAS-BLED - risk for major bleeding
CHADS-VASC - risk of thromboembolic event
determine if benefit outweighs the risk

Question 20

antithrombotic therapy for afib patients

Answer 20

warfarin for vlvular AF, otherwise NOAC for non-valvular AF

Question 21

common NOACs

Answer 21

dapigatran, rivaroxiban, apixaban