Clinical Approach to Chest Pain Flashcards
What are the 5 “killer” chest pains?
A. Acute Coronary Syndrome (ACS) B. Pulmonary Embolism C. Aortic Dissection D. Tension Pneumothorax E. Esophageal Rupture
What are some common causes of chest pain?
- Angina
- Myocardial infarction
- Aortic valve disease
- Hypertrophic or congestive cardiomyopathy
- Aortic dissection
- Pericarditis
- Mitral valve prolapse
What is Levine’s sign?
Fist clutched over the chest
What qualities of pain usually are NOT cardiac pain?
- Sharp stabbing pain
- Ache
What are some radiation points of pain that correlate with myocardial ischemia?
Neck, throat, lower jaw, teeth, upper extremity or shoulder
What is a good late marker of cardiac injury?
Troponin
What specific syndrome is elevated troponin a marker for?
non-ST elevation ACS
What is the BRUCE protocol?
It is the ramping measure used in the exercise stress test
Are upsloping ST segments on the EKG considered abnormal?
No
What are some non-cardiac causes of chest pain?
– Gastroesophageal reflux – Diffuse esophageal spasm – Cholecystitis and cholelithiasis – Pulmonary hypertension – Pneumothorax – Pulmonary embolism – Anxiety states – Herpes zoster – Cervical arthritis – Chest wall pain and tenderness
What are some factors predisposing a person to aortic dissection?
HTN, pregnancy, congenital defects
What does the D-dimer test have a high NPV for?
Pulmonary Embolism
What are the EKG signs of pericarditis?
ST elevation that is diffuse with PR depression
What does ST depression indicate?
Ischemia
What are the proximal types of aortic dissection?
Type 1 and 2
