Chief complaints of cardiology Flashcards
Discuss your management of acute chest pain
ABCDE assessment
12 lead ECG - identify any ST elevations
How do you manage acute chest pain with ST elevations on ECG?
Consult cardiology Immediate revascularization ASA ADP receptor inhibitor (clopidogrel) Anticoagulation Statin
How do you manage acute chest pain without ST elevations on ECG?
IV access
Monitor vitals
O2 if hypoxemic
Investigations
What do you suspect if a patient has acute chest pain, no ST elevation, increased troponin and CAD risk markers?
NSTEMI
What do you suspect if a patient has acute chest pain, normal troponin and CAD risk markers?
Unstable angina
What do you suspect if a patient has acute chest pain, mediastinal shift and absent lung marks?
Tension pneumothorax
What do you suspect if a patient has acute chest pain, prominent cardiac shadow, JVD and muffled heart sounds?
Cardiac tamponade
What do you suspect if a patient has acute chest pain, widened mediastinum and hypertension?
Aortic dissection
What do you suspect if a patient has acute chest pain and pneumomediastinum?
Oesophageal rupture
What do you suspect if a patient has acute chest pain, hypoxemia, elevated D dimer and Wells score>3?
PE
Name the criteria for the Wells score
Clinical signs HR >100bpm Immobilization >3 days Surgery within 4w Haemoptysis Malignancy Previous DVT/PE Alternative diagnosis less likely
Name cardiovascular causes of chest pain
STEMI NSTEMI Aortic dissection Cardiac tamponade Pericarditis Heart failure Takotsubo cardiomyopathy
Name the characteristic clinical features in a STEMI
Heavy, dull substernal pain N+V Diaphoresis Anxiety Syncope Improves w/ nitroglycerin
Name the diagnostic findings in a STEMI
ECG - ST elevation - T wave inversion - Q waves Bloods - incr troponin TTE - hypokinesis - regional wall abnormalities
Name the characteristic clinical features in a NSTEMI
Heavy, dull substernal pain N+V Diaphoresis Anxiety Syncope Improves w/ nitroglycerin
Name the diagnostic findings in a NSTEMI
ECG - nonspecific changes - ST depression - T wave inversion Bloods - incr/normal troponin TTE - regional wall abnormalities may be present
Name the characteristic clinical features in an aortic dissection
Severe, sharp tearing chest/abdominal pain Hypotension Syncope Neurological sx Assymetrical BP Pulse deficit New diastolic murmur MI sx
Name the diagnostic findings in an aortic dissection
ECG - nonspecific Bloods - elevated d dimer CXR - widened aorta CTA - intimal flap with false lumen TEE - proximal aortic dissection - tamponade - AR
Name the characteristic clinical features in cardiac tamponade
Beck's triad Pulsus paradoxus Tachycardia Dyspnea Cardiogenic shock
Name the diagnostic findings in cardiac tamponade
ECG - low voltage - electrical alternans CXR - cardiomegaly TTE - circumferential fluid layer - collapsible chambers - high EF - dilated IVC - inspiration, AV septa move left - expiration AV septa move right
Name the characteristic clinical features in pericarditis
Sharp, pleuritic restrosternal chest pain
Worse lying down
Pericardial rub
Name the diagnostic findings in pericarditis
ECG - ST elevation - PR depression - T wave inversion Bloods - incr ESR - incr CRP - leucocytosis - incr troponin CXR - normal TTE - pericardial effusion
Name the characteristic clinical features in heart failure exacerbation
Cough Dyspnea Hypoxemia Crackles JVD Peripheral edema
Name the diagnostic findings in heart failure exacerbation
Clinical diagnosis Bloods - incr BNP - incr troponin - hyponatremia CXR - diffuse opacities - Kerley B lines TTE - wall abnormalities - systolic/diastolic dysfunction - decreased LVEF
Name the characteristic clinical features in Takustubo cardiomyopathy
Hx of recent stressful event
Restrosternal pain
Dyspnea
Hypotensive shock
Name the diagnostic findings in Takutsubo cardiomyopathy
ECG - ST elevation - T wave inversion Bloods - incr troponin - incr BNP TTE - decr LVEF - wall motion abnormalities - apical ballooning cMRI - wall abnormalities - myocardial edema Coronary angiogram - normal
Name gastrointestinal causes of chest pain
Oesophageal perforation GERD Erosive oesophagitis PUD Acute pancreatitis Mallory-Weiss tears
Name the characteristic clinical features in oesophageal rupture
Restrosternal chest pain Neck pain Epigastric pain Dyspnea Tachycardia Dysphagia Mackler triad Mediastinal crepitus History of recent gastroscopy History of severe emesis
Name the diagnostic findings in oesophageal rupture
CXR - mediastinal/subdiphragmatic air - pneumothorax - pleural effusion NXR - subcutaneous emphysema Contrast esophography - contrast leak CT chest - extraluminal air - oesophageal thickening
Name the characteristic clinical features in GERD
Postprandial chest pain
Epigastric tenderness
Aggravating factors (foods, supine)
Name the diagnostic findings in GERD
EGD
24h pH monitoring
Name the characteristic clinical features in PUD
Epigastric pain Relieved by food = duodenal Exacerbated by food = gastric GI bleeding NSAID use
Name the diagnostic findings in PUD
Anemia
FOBT +
Urea breath test
EGD
Name the characteristic clinical features in acute pancreatitis
Severe epigastric pain that radiates to the back N+V Guarding, rigidity Hypoactive bowel sounds History of gallstones History of alcohol use
Name the diagnostic findings in acute pancreatitis
Bloods - incr lipase - incr amylase Abdominal U/S - pancreatic edema - peripancreatic fat stranding - gallstones
Name the characteristic clinical features in Mallory-Weiss syndrome
Epigastric pain Severe vomiting Hematemesis Malena Dizziness Syncope
Name the diagnostic findings in Mallory-Weiss syndrome
Anemia
EGD
Name pulmonary causes of chest pain
PE Pneumonia Pneumothorax (tension, spontaneous) Asthma COPD Pleural effusion
Name the characteristic clinical features in PE
Pleuritic chest pain Dyspnoea Hypoxemia Cough Haemoptysis Hypotension Shock
Name the diagnostic findings in PE
Bloods - incr d dimer - incr troponin - incr BNP CTA chest - pulmonary aa filling defect V/Q scan - perfusion ventilation mismatch TTE - right ventricle hypokinesis Wells score
Name the characteristic clinical features in tension pneumothorax
Severe, sharp chest pain Dyspnoea Hypoxemia Hx of trauma Hyperresonance Decr breath sounds Tracheal deviation Tachycardia Hypotension
Name the diagnostic findings in tension pneumothorax
Clinical diagnosis CXR - absent lung markings - tracheal deviation - pneumomediastinum
Name the characteristic clinical features in pneumonia
Fever Chills Cough Dyspnea Hypoxemia Crackles Egophony
Name the diagnostic findings in pneumonia
Bloods - leucocytosis - incr ESR/CRP - incr procalcitonin Positive sputum culture CXR - consolidation - pleural effusion CT chest w/ contrast - hyperdense consolidation
Name the characteristic clinical features in spontaneous pneumothorax
Sudden, sharp pain Dyspnea Hypoxemia Hyperresonance Decr breath sounds Crepitus
Name the diagnostic findings in spontaneous pneumothorax
CXR (in inspiration) - increased lucency - displaced lung markings - subcutaneous emphysema U/S - absent lung sliding
Name the characteristic clinical features in asthma
Dyspnea Cough Tachycardia Tachypnea Hypoxemia Wheezing Decr/absent breath sounds Incr work of breathing
Name the diagnostic findings in asthma
Respiratory acidosis
Decr peak expiratory flow
Name the characteristic clinical features in COPD
Dyspnea Cough Purulent sputum Tachypnea Hypoxemia Diffusing wheezing Decr breath sounds
Name the diagnostic findings in COPD
Bloods - respiratory acidosis - incr CRP - incr procalcitonin CXR - hyperinflation
Name the characteristic clinical features in pleural effusion
Unilateral, pleuritic chest pain Dyspnea Dry, non-productive cough Dullness to percussion Decr breath sounds Decr tactile fremitus Pleural friction rub
Name the diagnostic findings in pleural effusion
CXR - homogenous opacity - costophrenic angle blunting U/S - hypoechoic space between pleura
Name causes of dyspnea
Cardiac Respiratory - obstructive airway - lung parenchyma and pulmonary vessel - chest wall and pleural cavity Non-cardiorespiratory - CNS/neuromuscular - toxic/metabolic - other
Name acute cardiac causes of dyspnea with a normal CXR
ACS Myocardial contusion Arrythmias Myocarditis Pericarditis
Name chronic cardiac causes of dyspnea with a normal CXR
Arrythmias Non-dilated cardiomyopathy Valvular Cardiac shunt Physical deconditioning
Name acute cardiac causes of dyspnea with an abnormal CXR
Acute decompensated HF
Congestive HF
Pericardial effusion
Cardiac tamponade
Name chronic cardiac causes of dyspnea with an abnormal CXR
Pericardial effusion
Constrictive pericarditis
Dilated cardiomyopathy
Name acute upper airway obstructive disease causes of dyspnea
Anaphylaxis
Infection
FB aspiration
Angioedema
Name chronic upper airway obstructive disease causes of dyspnea
Head cancer
Neck cancer
Name acute lower airway obstructive disease causes of dyspnea
Asthma
COPD
Infection
Name chronic lower airway obstructive disease causes of dyspnea
COPD
Bronchiolitis obliterans
Lung cancer
Name acute lung parenchyma and pulmonary vessel causes of dyspnea with a normal CXR
PE
Idiopathic pulmonary aa hypertension
Name chronic lung parenchyma and pulmonary vessel causes of dyspnea with a normal CXR
Pulmonary right to left shunt
Name acute lung parenchyma and pulmonary vessel causes of dyspnea with an abnormal CXR
PE ARDS Acute chest syndrome Pulmonary contusion Pulmonary hemorrhage
Name chronic lung parenchyma and pulmonary vessel causes of dyspnea with an abnormal CXR
Interstitial lung disease
Lung cancer
Name acute chest wall and lung cavity causes of dyspnea
Pneumothorax
Chest wall injury
Pleural effusion
Name chronic chest wall and lung cavity causes of dyspnea
Pleural effusion
Chest wall abnormality
Diaphragm paralysis
Name acute CNS/neuromuscular causes of dyspnea
Stroke
Encephalitis
TBI
Neuromuscular disease
Name chronic CNS/neuromuscular causes of dyspnea
Neuromuscular disease
Name acute toxic/metabolic causes of dyspnea
Intoxication/overdose
DKA
Uremia
Name chronic toxic/metabolic causes of dyspnea
Acidosis
Hypermetabolic state
Name other acute causes of dyspnea
Psychogenic Acute renal failure Ascites Large hiatal hernia Chronic aspiration Hepatopulmonary syndrome
Name other chronic causes of dyspnea
Psychogenic
Anemia
Chronic kidney disease
