(MHD) Chest Pain Syndromes

Question 1

Why is it sometimes difficult to pin down a diagnoses when dealing with chest pain?

Answer 1

There is a lot of overlap with innervation, so a number of differentials pop up.

Question 2

What is the most important test for Pt. with chest pain?

Answer 2

EKG

Question 3

What are the (4) Killer causes of Chest Pain which should enter your differential?

Answer 3

1. Acute Coronary Syndromes
2. PE
3. Aortic Dissection
4. Tension Pneumothorax

Question 4

What is the name of the classic sign of angina pectoris? Describe it?

Answer 4

Levine’s Sign

Clutching of chest

Question 5

Why does angina pectoris often occur following a meal?

Answer 5

Blood gets shunted to the gut, which limits the amount getting to the heart.

Question 6

Pain or pressure under the left breast is ________ (often/rarely) cardiac.

Answer 6

Rarely

Question 7

What is the main treatment for an acute coronary syndrome?

Answer 7

Coronary angioplasty

Question 8

How do posterior infarctions appear on the ECG?

Answer 8

As reciprocal changes in anterior leads

Question 9

What can troponin readings tell you about cardiac injury? What is their limitation? How long does it take to appear in testing?

Answer 9

They tell you that a cardiac injury of some sort has occurred, but they do not indicate the mechanism of injury. Not usually elevated in the first few hours so a negative test acutely is not a definite indication that no damage has occurred.

Question 10

Main indications for stress testing (3)

What is the name of the protocal for the steps of the stress test?

Answer 10

1. Evaluation of chest pain
2. Evaluation of physical condition
3. Evaluation of medical therapy for angina

BRUCE protocal

Question 11

ST segment __________ (depression/elevation) with a _________ (positive/negative) sloping ST segment has the highest correlation with signficant CAD

Answer 11

segment depression …. negative sloping

Question 12

What change to lead 2 of the EKG indicates acute pericarditis?

Answer 12

PR depression

Question 13

4 general noncardiac causes of chest pain (4)

Answer 13

1. GI (reflux, esophageal spasm, etc.)
2. Pulmonary (PE, pulm hypertension, pneumothorax, etc.)
3. Emotional
4. Neuromuscular (herpes zoster, etc.)

Question 14

Signs and symptoms of aortic dissection

Answer 14

1. Cataclysmic, severe, tearing pain
2. Pulse deficit
3. Neurological deficits along the levels of the spine where the aorta has dissected.

Question 15

Main cause of aortic dissection

Answer 15

HYPERTENSION