CP Flashcards
What are the goals for CP in primary care?
- Don’t kill patients
- Exclude things that make people die
- Find those at risk and intervene NOW
What is clutching of the chest called?
Levine sign
What are differenttial for CP?
- CV
- Trauma/MS
- Pulmonary
- Infectious
- Other
What are the CV disorders?
- ACS
- AAA
- AS
What are the Trauma/MS disorders?
- Chest wall fx/contusion
- PTX
- Boehaaves syndrome
- Costchondritis
CP differential for pulmonary
PE
CP differential for infection
- Pleurisy
- PNA
- Myocarditis
What are other CP differential
- GI (GERD, esophageal, PUD, GB, psych, toxicity)
what is the most common cause of CP in office?
Chest wall syndrome
Whats the most common cause of CP?
- MSK
- Nonspecific CP
- GI
If its non of the dx listed on the chart, what can you call it?
Chest wall syndrome
if there is any concerns for ABC what should you do?
Emergent transfer to the ER
what should you obtain in CP visit?
ECG
Aggravating factors postprandial?
GI
Aggravating factors exertion?
Cardiac
Aggravating factors cold, emotional stress, sexual intercourse?
cardiac
Aggravating factors worse with swallowing?
esophageal origin
Aggravating factors body position, movement, deep breathing?
MSK
Alleviating factors w/ antacids/food?
GI
Sublingual nitro alleviating factors?
Esophageal or cardiac
“GI cocktail” alleviating factors?
GI or cardiac
cessation of pain with rest?
alleviating factors?
Cardiac
Sitting up and leaning forward alleviating factors?
Pericarditis
Bleching, bad taste in mouth, dysphagia HPI assocaited sx?
Esophageal dz
Vomiting HPI assocaited sx?
MI or GI
Diaphoresis HPI associated sx?
MI, possibly esophageal dz
Syncope HPI associated sx?
dissection, PE, AS, ruptured AAA
Near syncope HPI associated sx?
MI
Fatigue HPI associated sx?
MI in elderly
HPI region/location
larger areas of discomfort more likely ischemic etiolgoy
T/F severity is useful in predictor for presence of CAD?
False, not useful predictor
Whats the timing of HPI, Abrupt onset with greatest intensity in beginning
PTX, dissection, acute P
Whats the timing of HPI, gradual increasing onset overtime
Ischemic
Whats the timing of HPI, crescendo pattern
esophageal dz
Whats the timing of HPI, lasts for seconds or constant over weeks
not related to ischemic
Whats the timing of HPI, circadian rhythm?
correlating with increase sympathetic tone- more likely ischemia
What are PE that point towards ACS?
- S3 or S4
- Systolic BP <80 mm/Hg
- Crackles on auscultation
T/F Absence of S3 or S4, Systolic BP <80 mm/Hg, Crackles on auscultation exclude ACS
False!! it does not exclude ACS
if the ECG shows no signs and cp suspicious for CAD, what should you do?
- get cardiac biomarkers to eval for non-ST elevation MI
- consider c-xray if they have resp disease
what is the standard of care in the ED?
Only an initial trop if >3 hours from onset
If under 3 hours need a second one an hour later
outpt troponin for pt with sx suggestive of acute coronary syndrone is?
transfer for eval w/o troponin testing
is it reasonable to use single troponin test to exclude acute MI?
Only with asymptomatic patients whose symptoms resolved at least 12 hours prior, so long as they have no high-risk features and a normal electrocardiogram.
if a pt is better with nitro, can they go home?
NOOO
can post-parandial pain be ischemic?
yes!
