PANCE Cardiology #2 Chest Pain Flashcards
Name 5 common risk factors for chest pain?
Most common risk factor for CAD?
which is the worst risk factor?
which when corrected will show the biggest improvement?
HTN, DM2, hyperlipidemia, smokr, fam hx
fam hx includes father <65yo
Name what you COULD find on exam for LV dysfunction. 4 things
JVD
S3
S4
rales
the is the most common exam finding for LV?
normal
Ischemic pain duration?
Quality?
Character?
10-30 minutes (if its seconds or days=not ischemic)
dull, sore, squeezing (not sharp)
tightness, heaviness, pressure
Inferior wall ischemia may present with vagal reflexes.
bradycardia, hypotension, dizziness/fainting
ischemic pain is not? 3 things
positional, pluritic, tender to palpation
can you rule out transient ischemia from esophagea; spasm with nitroglycerin?
What can you use as a response to therapy to make a diagnosis?
opioids?
esophageal candidasis?
NO!!!
nitro causes vaso-dilation of lower esophageal sphincter which makes GERD worse.
Narcan.
fluconazole.
True infarction lasts?
20-30 minutes
Initail impression,
diphoresis, tachypnea, anxious should alert PA to life threatening process.
example=tachy, tachy?
B/P difference of 20mmHg is present in?
PE
aortic dissection
The most common physcial exam finding for MI?
nothing.
What is a wide split of S2 indicative of? 4 things
What is a new paradoxic split of S2? 5 things
RBBB. right ventricular hypertrophy/infarct pulm HTN pulmonic stenosis q#2 LBBB, ant or lateral infarct, HTN, aortic stenosis, LVH
What is the only thing that gives you a fixed split of the S2?
atrial septal defect.
What is a S4 gallop indicative of ?
Patient comes in with 20yr hx of HTN what do you expect to find?
What will you do differently on the bases of this finding?
LVH (atrial systole=blood splashes against vent wall)
nothing. tx htn
What do you do with a S3?
CHF, need meds quick, you gonna be sick!!!
INCREASE THEARAPY
splashy, splashy=fluid overload
tx=diuretic, ace
with new onset aortic regurgitation, you will find 50% of patients with ?
mitral regurgitation
new onset mitral regurge is attributed to
papillary musce detachment/dysfunction
up to how many hours does it take CKMB and troponins to elevate?
up to how many hours after onset of chest pain are thromboilytic indicated?
4hrs
12hrs
when do you initiate Tpa?
ST segemnt elevation. STEMI
on an ekg, what is indicative of a st elevation mi?
st segment elevated >1mm, in 2 leads.
pt who had mi 5 days ago presents with new onset chest pain. What cardiac enzyme do you want?
Troponin is also elevated in ?
CK-MB because they are out of the system in 3-4 days. Troponins are in your system for wks.
Renal dz
How do you differentiate cardia chest pain from non-cardiac chest pain?
pleuritic, positional or tender
sx of
1) costochondritis
2) GERD
3) peptic ulcer
4) gallbladder dz
5) MI
6) aortic stenosis
7) myocarditis
8) pericarditis
9) dissecting aortic aneurysm
10) mitral valve prolaps
11) PE
12) pneumothorax
1) pain exacerbated by inspiration; reproduced by chest wall palpation
2) acid reflux, relief with antacids
3) epigastric pain
4) RUQ abdo pain and tenderness
5) pain more sever, 20-30 minutes
6) systolic ejection murmur
7) pain is vague and mild
8) pain is sharp, worse when lying down, relieved when sitting up (positional and pleurtic)
9) pain is sharp and tearing, felt in the back
10) transient pain, midsystolic click
11) tachypnea, dyspnea, pleuritic pain
12) sudden onset of pain + dyspnea
aortic dissection key characteristic 4things
first diagnostic test?
diagnosis confirmed by?
widened mediastinum pain radiating to back loss of pulses test= x-ray MRI, CT, TEE(transesophagealecho
name causes of pleuritic pain? 4 P’s
Which of these can give you a fever?
PE Pneumonia pericarditis pneumothorax pleuritis all of them can give you a fever.
pregnant woman with PE what do you get
VQ scan
pericarditis is precede by a…
what do you hear on auscultaion..
single most specific test for pericarditis?
treatment?
viral illness
friction rub
PR- segment depression, diffuse ST segment elevation
tx? NSAIDS, then steroids
most specific test to diagnose myocarditis?
biopsy
What comprises ACS?
What do you differentiate with these 2 dx’s?
Which gets thrombolytics/angioplasty
unstable angina/ MI
STEMI / NSTEMI
STEMI
