Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MHD 1 > L44 Clinical Approach to the Patient with Chest Pain > Flashcards

L44 Clinical Approach to the Patient with Chest Pain Flashcards

1
Q

Why is chest pain a clinical challenge?

A
  1. Frequent overlap of signs and symptoms

2. Common mechanism of pain perception (same spinal cord sensory innervation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The majority of non-emergent chest pain is ___ in origin. What are the 2nd and 3rd most common causes?

A

Musculoskeletal; GI; cardiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 4 killer chest pain causes?

A
  1. Acute coronary syndromes (unstable angina, NSTEMI, STEMI)
  2. Pulmonary Embolism
  3. Aortic Dissection
  4. Tension Pneumothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some common cardiac causes of chest pain?

A
  1. Angina
  2. MI
  3. Aortic valve disease
  4. Hypertrophic or congestive cardiomyopathy
  5. Aortic dissection
  6. Pericarditis
  7. Mitral valve prolapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the classic signs of angina pectoris?

A

Grasping the chest, pain across the substernum, radiates down the left arm, drop what is being carried, precipitated by a heavy meal, cold, exertion, and hypoxic environments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

After the substernum, what are the most common areas for angina to present?

A

Jaw, epigastrum, inner aspect of the left arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What types of pain are rarely/never cardiac in origin?

A

Pain or pressure lasting seconds (sharp, stabbing), under the left breast, and below the umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some physical signs of a patient in acute CAD?

A

Pallor, sweating, anxiety, tachycardia, rise in blood pressure, S4 gallop, mitral regurgitation murmur, paradoxically split S2, pulsus alternans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes pallor, sweating, anxiety, tachycardia, and rise in blood pressure?

A

Sympathetic stimulation by pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes an S4 gallop?

A

Decreased LV compliance due to ischemia or infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What causes mitral regurgitation?

A

Inferior wall ischemia or infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes a paradoxically split S2?

A

New left bundle branch block and possible acute MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What causes pulsus alternans?

A

Impending LV failure and cardiogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the pathophysiology of unstable angina and acute MI.

A

A non-vulnerable atherosclerotic plaque becomes vulnerable by developing a lipid core. Physical or mental stress can trigger a plaque rupture. Rupture leads to formation of a thrombosis (either occlusive or non-occlusive). The non-occlusive thrombus can be asymptomatic or cause unstable angina or Non-Q MI. Occlusive thrombus causes MI or sudden cardiac death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In an acute MI, discuss the % of normal, abnormal, and typical ECG that will present.

A

10% normal
40% abnormal, but non-diagnostic
50% typical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the characteristic features of ECG when a patient has an acute infarction?

A
  1. Elevated ST segments
  2. Inverted T waves over time
  3. Development of Q waves within 12 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What issues look like acute MI on ECG?

A
  1. Pericarditis
  2. J-point elevation
  3. WPW syndrome
18
Q

When is it difficult to use ECG to diagnose MI?

A
  1. LBBB

2. Patient with a pacemaker

19
Q

ST depression represents ___; ST elevation represents ___.

A

Ischemia; infarction

20
Q

What biomarker is diagnostic for acute coronary syndrome/cardiac injury?

A

Troponin ( and T)

21
Q

In addition to being diagnostic, troponin is also ___.

A

Prognostic

22
Q

What is stable angina?

A

Angina that occurs at a predictable amount of energy expenditure or emotion.

23
Q

What are the measurable signs of ischemia over time (in order).

A
  1. Relaxation failure
  2. Contraction failure
  3. Filling pressure increases
  4. EKG changes
  5. Angina
24
Q

Describe the classes of angina pectoris according to Canadian Classification.

A

I: ordinary activity does not cause angina; occurs with strenuous activity

II: slight limitation of ordinary activity; occurs with walking rapidly/uphill

III: marked limitations of ordinary physical activity

IV: inability to carry on any physical activity without discomfort, may be present at rest

25
Q

What are the indications of stress testing?

A
  1. Evaluation fo chest pain
  2. Estimating progress and severity of disease
  3. Evaluation of therapy
  4. Screening for latent coronary disease
  5. Evaluation fo arrhythmias
26
Q

The stress test EKG looks for what signs of distress?

A

ST segment depression or elevation; 1+ mm depression with a horizontal or downward slope is positive for ischemia

27
Q

What is on the differential for MI?

A
  1. Dissecting aortic aneurysm
  2. Pericarditis
  3. Pulmonary embolism
  4. Pneumonia
  5. Costochondritis
  6. Esophageal disease
  7. Peptic ulcer disease
  8. Biliary colic
28
Q

What does the EKG look like in pericarditis?

A

Diffuse ST elevation to possible 2mm

29
Q

What are the three major symptoms of aortic stenosis?

A
  1. CHF
  2. Syncope
  3. Angina pectoris

Can be asymptomatic

30
Q

Describe the hemodynamics of aortic stenosis.

A

AS creates a pressure gradient between the LV and aorta and leads to LV hypertrophy.

31
Q

What is idiopathic hypertrophic subaortic stenosis?

A

Cardiomyopathy characterized by marked hypertrophy of the left ventricle with asymmetrical hypertrophy of the IV septum out of proportion to the LV free wall, often resulting in a dynamic obstruction of the LV outflow tract.

32
Q

What are GI causes of chest pain?

A
  1. Gastroesophageal reflux
  2. Diffuse esophageal spasm
  3. Cholecystitis and cholelithiasis
33
Q

What are pulmonary causes of chest pain?

A
  1. Pulmonary hypertension
  2. Pneumothorax
  3. Pulmonary embolism
34
Q

What are emotional causes of chest pain?

A
  1. Anxiety/hyperventilation

2. Depression

35
Q

What are neuromuscular causes of chest pain?

A
  1. Herpes zoster
  2. Cervical arthritis
  3. Chest wall pain and tenderness
36
Q

Describe the three types of aortic dissection.

A

Type I: proximal, dissected all the way down
Type II: proximal, localized
Type III: below left subclavian, distal

37
Q

What are the symtpoms of aortic dissection?

A

Pain (cataclysmic onset, tearing, stabbing, tends to migrate, anterior thorax proximally and interscapular distally)

Pulse deficit, aortic regurgitation, CVA, paraparesis, peripheral neuropathy, vasovaga

38
Q

Discuss the epidemiology and predisposing factors of aortic dissection.

A

Men (50-60 years old) are 2x as likely to have it; occurs proximally twice as often

HYPERTENSION, pregnancy, congenital issues

39
Q

What is a pneumothorax?

A

Air in the pleural space (can be spontaneous or secondary)

40
Q

What is a tension pneumothorax?

A

Life-threatening condition resulting from progressive deterioration of a simple pneumothroax associated with the formation of a one-way valve at the point of rupture.

41
Q

At least 30% of patients with chest pain are found to have a ___ disease.

A

GI

MHD 1 (58 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions