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Internal medicine > Chief complaints of cardiology > Flashcards

Chief complaints of cardiology Flashcards

1
Q

Discuss your management of acute chest pain

A

ABCDE assessment

12 lead ECG - identify any ST elevations

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2
Q

How do you manage acute chest pain with ST elevations on ECG?

A 
Consult cardiology
Immediate revascularization
ASA 
ADP receptor inhibitor (clopidogrel)
Anticoagulation
Statin
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3
Q

How do you manage acute chest pain without ST elevations on ECG?

A

IV access
Monitor vitals
O2 if hypoxemic
Investigations

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4
Q

What do you suspect if a patient has acute chest pain, no ST elevation, increased troponin and CAD risk markers?

A

NSTEMI

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5
Q

What do you suspect if a patient has acute chest pain, normal troponin and CAD risk markers?

A

Unstable angina

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6
Q

What do you suspect if a patient has acute chest pain, mediastinal shift and absent lung marks?

A

Tension pneumothorax

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7
Q

What do you suspect if a patient has acute chest pain, prominent cardiac shadow, JVD and muffled heart sounds?

A

Cardiac tamponade

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8
Q

What do you suspect if a patient has acute chest pain, widened mediastinum and hypertension?

A

Aortic dissection

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9
Q

What do you suspect if a patient has acute chest pain and pneumomediastinum?

A

Oesophageal rupture

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10
Q

What do you suspect if a patient has acute chest pain, hypoxemia, elevated D dimer and Wells score>3?

A

PE

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11
Q

Name the criteria for the Wells score

A 
Clinical signs
HR >100bpm
Immobilization >3 days
Surgery within 4w
Haemoptysis
Malignancy
Previous DVT/PE
Alternative diagnosis less likely
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12
Q

Name cardiovascular causes of chest pain

A 
STEMI
NSTEMI
Aortic dissection
Cardiac tamponade
Pericarditis
Heart failure
Takotsubo cardiomyopathy
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13
Q

Name the characteristic clinical features in a STEMI

A 
Heavy, dull substernal pain
N+V
Diaphoresis
Anxiety
Syncope
Improves w/ nitroglycerin
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14
Q

Name the diagnostic findings in a STEMI

A 
ECG
- ST elevation
- T wave inversion
- Q waves
Bloods
- incr troponin
TTE
- hypokinesis
- regional wall abnormalities
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15
Q

Name the characteristic clinical features in a NSTEMI

A 
Heavy, dull substernal pain
N+V
Diaphoresis
Anxiety
Syncope
Improves w/ nitroglycerin
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16
Q

Name the diagnostic findings in a NSTEMI

A 
ECG
- nonspecific changes
- ST depression
- T wave inversion
Bloods
- incr/normal troponin
TTE
- regional wall abnormalities may be present
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17
Q

Name the characteristic clinical features in an aortic dissection

A 
Severe, sharp tearing chest/abdominal pain
Hypotension
Syncope
Neurological sx
Assymetrical BP
Pulse deficit
New diastolic murmur
MI sx
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18
Q

Name the diagnostic findings in an aortic dissection

A 
ECG
- nonspecific
Bloods
- elevated d dimer
CXR
- widened aorta
CTA
- intimal flap with false lumen
TEE
- proximal aortic dissection
- tamponade
- AR
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19
Q

Name the characteristic clinical features in cardiac tamponade

A 
Beck's triad
Pulsus paradoxus
Tachycardia
Dyspnea
Cardiogenic shock
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20
Q

Name the diagnostic findings in cardiac tamponade

A 
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
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21
Q

Name the characteristic clinical features in pericarditis

A

Sharp, pleuritic restrosternal chest pain
Worse lying down
Pericardial rub

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22
Q

Name the diagnostic findings in pericarditis

A 
ECG
- ST elevation
- PR depression
- T wave inversion
Bloods
- incr ESR
- incr CRP
- leucocytosis
- incr troponin
CXR
- normal
TTE
- pericardial effusion
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23
Q

Name the characteristic clinical features in heart failure exacerbation

A 
Cough
Dyspnea
Hypoxemia
Crackles
JVD
Peripheral edema
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24
Q

Name the diagnostic findings in heart failure exacerbation

A 
Clinical diagnosis
Bloods
- incr BNP
- incr troponin
- hyponatremia
CXR
- diffuse opacities
- Kerley B lines
TTE
- wall abnormalities
- systolic/diastolic dysfunction
- decreased LVEF
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25
Q

Name the characteristic clinical features in Takustubo cardiomyopathy

A

Hx of recent stressful event
Restrosternal pain
Dyspnea
Hypotensive shock

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26
Q

Name the diagnostic findings in Takutsubo cardiomyopathy

A 
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
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27
Q

Name gastrointestinal causes of chest pain

A 
Oesophageal perforation
GERD
Erosive oesophagitis
PUD
Acute pancreatitis
Mallory-Weiss tears
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28
Q

Name the characteristic clinical features in oesophageal rupture

A 
Restrosternal chest pain
Neck pain
Epigastric pain
Dyspnea
Tachycardia
Dysphagia
Mackler triad
Mediastinal crepitus
History of recent gastroscopy
History of severe emesis
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29
Q

Name the diagnostic findings in oesophageal rupture

A 
CXR
- mediastinal/subdiphragmatic air
- pneumothorax
- pleural effusion
NXR
- subcutaneous emphysema
Contrast esophography
- contrast leak
CT chest
- extraluminal air
- oesophageal thickening
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30
Q

Name the characteristic clinical features in GERD

A

Postprandial chest pain
Epigastric tenderness
Aggravating factors (foods, supine)

31
Q

Name the diagnostic findings in GERD

A

EGD

24h pH monitoring

32
Q

Name the characteristic clinical features in PUD

A 
Epigastric pain
Relieved by food = duodenal
Exacerbated by food = gastric
GI bleeding
NSAID use
33
Q

Name the diagnostic findings in PUD

A

Anemia
FOBT +
Urea breath test
EGD

34
Q

Name the characteristic clinical features in acute pancreatitis

A 
Severe epigastric pain that radiates to the back
N+V
Guarding, rigidity
Hypoactive bowel sounds
History of gallstones
History of alcohol use
35
Q

Name the diagnostic findings in acute pancreatitis

A 
Bloods
- incr lipase
- incr amylase
Abdominal U/S
- pancreatic edema 
- peripancreatic fat stranding
- gallstones
36
Q

Name the characteristic clinical features in Mallory-Weiss syndrome

A 
Epigastric pain
Severe vomiting
Hematemesis
Malena
Dizziness
Syncope
37
Q

Name the diagnostic findings in Mallory-Weiss syndrome

A

Anemia

EGD

38
Q

Name pulmonary causes of chest pain

A 
PE
Pneumonia
Pneumothorax (tension, spontaneous)
Asthma
COPD
Pleural effusion
39
Q

Name the characteristic clinical features in PE

A 
Pleuritic chest pain
Dyspnoea
Hypoxemia
Cough
Haemoptysis
Hypotension
Shock
40
Q

Name the diagnostic findings in PE

A 
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
41
Q

Name the characteristic clinical features in tension pneumothorax

A 
Severe, sharp chest pain
Dyspnoea
Hypoxemia
Hx of trauma
Hyperresonance
Decr breath sounds
Tracheal deviation
Tachycardia
Hypotension
42
Q

Name the diagnostic findings in tension pneumothorax

A 
Clinical diagnosis
CXR
- absent lung markings
- tracheal deviation
- pneumomediastinum
43
Q

Name the characteristic clinical features in pneumonia

A 
Fever
Chills
Cough
Dyspnea
Hypoxemia
Crackles
Egophony
44
Q

Name the diagnostic findings in pneumonia

A 
Bloods
- leucocytosis
- incr ESR/CRP
- incr procalcitonin
Positive sputum culture
CXR
- consolidation
- pleural effusion
CT chest w/ contrast
- hyperdense consolidation
45
Q

Name the characteristic clinical features in spontaneous pneumothorax

A 
Sudden, sharp pain
Dyspnea
Hypoxemia
Hyperresonance
Decr breath sounds
Crepitus
46
Q

Name the diagnostic findings in spontaneous pneumothorax

A 
CXR (in inspiration)
- increased lucency
- displaced lung markings
- subcutaneous emphysema
U/S
- absent lung sliding
47
Q

Name the characteristic clinical features in asthma

A 
Dyspnea
Cough
Tachycardia
Tachypnea
Hypoxemia
Wheezing
Decr/absent breath sounds
Incr work of breathing
48
Q

Name the diagnostic findings in asthma

A

Respiratory acidosis

Decr peak expiratory flow

49
Q

Name the characteristic clinical features in COPD

A 
Dyspnea
Cough
Purulent sputum
Tachypnea
Hypoxemia
Diffusing wheezing
Decr breath sounds
50
Q

Name the diagnostic findings in COPD

A 
Bloods
- respiratory acidosis
- incr CRP
- incr procalcitonin
CXR
- hyperinflation
51
Q

Name the characteristic clinical features in pleural effusion

A 
Unilateral, pleuritic chest pain
Dyspnea
Dry, non-productive cough
Dullness to percussion
Decr breath sounds
Decr tactile fremitus
Pleural friction rub
52
Q

Name the diagnostic findings in pleural effusion

A 
CXR
- homogenous opacity
- costophrenic angle blunting
U/S
- hypoechoic space between pleura
53
Q

Name causes of dyspnea

A 
Cardiac
Respiratory
- obstructive airway
- lung parenchyma and pulmonary vessel
- chest wall and pleural cavity
Non-cardiorespiratory
- CNS/neuromuscular 
- toxic/metabolic
- other
54
Q

Name acute cardiac causes of dyspnea with a normal CXR

A 
ACS
Myocardial contusion
Arrythmias
Myocarditis
Pericarditis
55
Q

Name chronic cardiac causes of dyspnea with a normal CXR

A 
Arrythmias
Non-dilated cardiomyopathy
Valvular
Cardiac shunt
Physical deconditioning
56
Q

Name acute cardiac causes of dyspnea with an abnormal CXR

A

Acute decompensated HF
Congestive HF
Pericardial effusion
Cardiac tamponade

57
Q

Name chronic cardiac causes of dyspnea with an abnormal CXR

A

Pericardial effusion
Constrictive pericarditis
Dilated cardiomyopathy

58
Q

Name acute upper airway obstructive disease causes of dyspnea

A

Anaphylaxis
Infection
FB aspiration
Angioedema

59
Q

Name chronic upper airway obstructive disease causes of dyspnea

A

Head cancer

Neck cancer

60
Q

Name acute lower airway obstructive disease causes of dyspnea

A

Asthma
COPD
Infection

61
Q

Name chronic lower airway obstructive disease causes of dyspnea

A

COPD
Bronchiolitis obliterans
Lung cancer

62
Q

Name acute lung parenchyma and pulmonary vessel causes of dyspnea with a normal CXR

A

PE

Idiopathic pulmonary aa hypertension

63
Q

Name chronic lung parenchyma and pulmonary vessel causes of dyspnea with a normal CXR

A

Pulmonary right to left shunt

64
Q

Name acute lung parenchyma and pulmonary vessel causes of dyspnea with an abnormal CXR

A 
PE
ARDS
Acute chest syndrome
Pulmonary contusion
Pulmonary hemorrhage
65
Q

Name chronic lung parenchyma and pulmonary vessel causes of dyspnea with an abnormal CXR

A

Interstitial lung disease

Lung cancer

66
Q

Name acute chest wall and lung cavity causes of dyspnea

A

Pneumothorax
Chest wall injury
Pleural effusion

67
Q

Name chronic chest wall and lung cavity causes of dyspnea

A

Pleural effusion
Chest wall abnormality
Diaphragm paralysis

68
Q

Name acute CNS/neuromuscular causes of dyspnea

A

Stroke
Encephalitis
TBI
Neuromuscular disease

69
Q

Name chronic CNS/neuromuscular causes of dyspnea

A

Neuromuscular disease

70
Q

Name acute toxic/metabolic causes of dyspnea

A

Intoxication/overdose
DKA
Uremia

71
Q

Name chronic toxic/metabolic causes of dyspnea

A

Acidosis

Hypermetabolic state

72
Q

Name other acute causes of dyspnea

A 
Psychogenic
Acute renal failure
Ascites
Large hiatal hernia
Chronic aspiration
Hepatopulmonary syndrome
73
Q

Name other chronic causes of dyspnea

A

Psychogenic
Anemia
Chronic kidney disease

Internal medicine (16 decks)

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