MHD: Chest Pain Flashcards
What are the most common causes of non-emergent chest pain?
Musculoskeletal (36%) GI (19%) Cardiac (16%) Psych (8%) Pulmonary (5%)
What are the emergent causes of chest pain?
Acute coronary syndromes
Pulmonary embolism
Aortic dissection
Tension pneumothorax
List the common cardiac causes of chest pain
Angina MI Aortic valve disease Hypertrophic or congestive cardiomyopathy Aortic dissection Pericarditis Mitral valve prolapse
Describe the 3 locations of pain associated with chest pain
Most common: substernal
2nd: Epigastric and along the medial left arm
3rd: Neck, right shoulder, medial right arm
How is cardiac chest pain classically described?
Crushing pain, pressure, tightness
Over 50% of the time this indicates cardiac involvement (30% angina, 24% MI)
What are the physical signs of acute CAD?
Pallor, sweatting, anxiety, tachycardia, elevated BP, S4 gallop, mitral regurgitation murmur, paradoxically split S2, pulsus alterans
What are the 3 categories of acute coronary syndrome?
Unstable angina
NSTEMI
STEMI
Describe how daily activities can trigger coronary thrombosis
A vulnerable atherosclerotic plaque can rupture due to stress.
Minor ruptures can lead to nonocclusive thrombi and unstable angina, or a nonQ MI
Major ruptures can lead to occlusive thrombus and MI or sudden cardiac death
What is the #1 diagnostic tool for acute MI?
ECG
50% will show typical signs of MI, 40% will be abnormal, but not diagnostic, and 10% will appear normal
What are the ECG features of an acute infarction?
Elevated ST segments, inverted T waves and the development of Q waves
What conditions often appear like an MI on ECG?
ECG impostors: Pericarditis, J-point elevation, WPW syndrome
How does a posterior MI appear on ECG?
Reciprocal changes in the anterior leads (depressed ST segment, tall upright T waves, prominent R waves)
What is a troponin lab test used for?
Lab test that is specific for cardiac injury ~24 hrs after MI
What is stable angina?
Chest pain occurring with exertion in a predictable and consistent way
Describe the sequence of ischemic changes that occur following an occlusion
Relaxation failure Contraction failure Increased filling pressure ECG changes Angina (~25 seconds after occlusion)
Describe the Canadian cardiovascular society classification system for angina pectoris
I-IV scale with I and II representing stable angina, III and IV representing unstable angina.
Categories are separated based on the impact of physical activity
What are the indications for a treadmill stress test?
Evaluation of chest pain Estimating progress and severity of disease Evaluation of therapy Screening for latent coronary disease Evaluation of arrhythmias
Describe the ECG during an exercise stress test of a normal individual
Upsloping ST segment
Describe the abnormal pathological finding on an ECG during an exercise stress test
Horizontal or downsloping ST segment
How does pericarditis appear on an ECG?
Diffuse ST elevation
PR depression
Describe the hemodynamics of aortic stenosis
The hardened aortic valve creates an increased pressure in the left ventricle during systole. This presents as a systolic ejection murmur.
What is IHSS?
Idiopathic hypertrophic subaortic stenosis
Cardiomyopathy with asymmetrical hypertrophy of the intraventricular septum without equivalent hypertrophy of the free wall
What are the GI causes of chest pain?
GERD
Esophageal spasm
Cholecystitis
What are the pulmonary causes of chest pain?
Pulmonary hypertension
Pneumothorax
Pulmonary embolism
