L3 - Chest Pain Flashcards
What does HBP stand for?
High blood pressure
What does GTN stand for?
Glycerinetrinitrate
How often is chest pain diagnosed?
Chest pain is not a diagnosis. It is a symptom
Diagnosis = chest pain due to X
What is Levine’s Sign?
When a person grips their chest with a fist during chest pain
It suggests cardiac involvement
When do you do ECG?
Once during chest pain & once after
How does the ECG appear during cardiac related chest pain?
ST segment elevation or depression
How to decrease HR & BP?
Beta Blockers
How to decrease LV stiffness & LVEDP?
Nitro –> decreased venous return to heart
Sharp chest pain would suggest what?
Non-cardiac
Squeezing/pressing chest pain would suggest what?
Cardiac
Aching chest pain would suggest what?
Cardiac
Dull chest pain would suggest what?
Cardiac
Burning chest pain would suggest what?
Cardiac (exception = GERD)
Visceral/deep chest pain would suggest what?
Cardiac (exception = GERD)
Superficial chest pain would suggest what?
Non-cardiac
Substernal chest pain would suggest what?
Cardiac (exception = GERD)
Severe chest pain would suggest what?
Cardiac more likely but not a certainty
Mild chest pain would suggest what?
Non-cardiac but not a certainty
Chest pain for seconds would suggest what?
Non-cardiac
Chest pain for minutes would suggest what?
Cardiac
Chest pain for hours would suggest what?
Non-cardiac, but MI can present with this long of pain
Chest pain associated with movement of the neck, arm or shoulder would suggest what?
Non-cardiac but not a certainty
What would random (no precipitating factor) chest pain suggest?
Doesn’t fit the classic picture of cardiac chest pain, but doesn’t really point strongly one way or the other
Chest pain that follows exertion would suggest what?
Cardiac
<p>
| Chest pain following a meal would suggest what?</p>
<p> Cardiac </p> <p> or</p> <p> Esophogeal Spasm</p>
Chest pain following exposure to heat or cold would suggest what?
Cardiac
Chest pain following an emotional situation would suggest what?
Cardiac
Adrenaline rush
Chest pain relieved by nitrates would suggest what?
Cardiac
Chest pain that is alleviated by eating suggests what?
Non-cardiac
Chest pain alleviated by antacids suggest what?
Non-cardiac
Chest pain with breathlessness would suggest what?
Cardiac (high pressure builds up into pulmonary HTN)
Chest pain that occurs while sleeping suggests what?
Cardiac more likely
More venous return when lie down
Chest pain that occurs early in the morning suggests what?
Cardiac more likely
Platelets stickier during morning
How to decrease platelet adhesion?
Baby aspirin
How do you do an ECG if the patient isn’t having chest pain at that moment?
Stress test (treadmill) —> try to induce cardiac event
ST elevation on an ECG suggests what?
MI
Visceral substernal epigastric pain that lasts 30 minutes. Does not radiate. Exacerbated by not eating & recumbency (resting). Alleviated with antacids. Diagnosis?
GERD
What non-cardiac cause mimics cardiac angina most closely?
Esophogeal spasm
Visceral substernal epigastric pain & burning for hours. Brought on by certain foods or not eating. Alleviated by antacids. Diagnosis?
Peptic Ulcer
Superficial arm, neck & chest pain that is not relieved by rest. Alleviated by analgesia. Pain worsens with head, arm or shoulder movement. Pain worsens due to palpation. Diagnosis?
Cervical disk problem & nerve compression
Superficial tenderness exacerbated by movement or palpation located on the chest. Alleviated with time or analgesia. Diagnosis?
Musculoskeletal
Visceral substernal pain that lasts for a few minutes following an emotion situation. Facial paresthesia (tingling). Alleviated by removing emotional stimulus. Diagnosis?
Emotional hyperventilation
Severe visceral substernal chest pain lasting hours to days. Spontaneous provocation & relief by nitro. Diagnosis?
MI
When do you give morphine for chest pain?
Not first. It will alleviate any pain so it gives you no info.
Give nitro first, then IV analgesics
Substernal poorly localized and radiating chest pain that is brought on by effort or emotion lasting 5-15 minutes. Alleviated with nitro or rest. Diagnosis?
Effort Angina
When is effort angina the worst?
First episode is most vivid
Poorly localized substernal visceral pain that radiates and arises spontaneously. Lasts 5-15 minutes. Alleviated by nitro. Diagnosis?
Rest angina
Visceral substernal radiating pain that lasts 5-60 minutes. Arises spontaneously or in relation to exercise, food or cold. Alleviated by nitro. Diagnosis?
Esophogeal spasm but really similar to cardiac cause
How to differentiate GERD and Peptic ulcers?
Peptic ulcers pain generally last hours while GERD generally lasts for about a half hour
