Patient with Chest Pain and Structural Heart Disease Flashcards
Causes of chest pain can range from emergent to benign and it is your job to what?
thoroughly investigate to discover what the true etiology is
What is the “BIG 6”
1) Acute Myocardial Infarction/Unstable Angina.
2) Pulmonary Embolism (PE)
3) Pericardial Tamponade
4) Esophageal Rupture
5) Tension Pneumothorax/Pneumothorax
6) Aortic Dissection/Rupture
If you can rule out the big 6, you can very likely feel that the patient will survive the next ____.
24 hours
Treatment for chest pain…..
What if its one of the big 6?
Treat underlying cause
If the diagnosis is one of the big 6, then remember ABCs, IV, O2 if saturation < 94%, Monitor and appropriate treatment, then TRANSFER ASAP
What is the Cardiac valves main job in the body?
create one-way flow in the heart
Another name for leaking heart valve. Occurs when blood flows back through the valve as the leaflets are closing, or leaks through the leaflets when they should be completely closed
Regurgitation
Is a term for a valve that doesn’t open properly. The flaps of the valve thicken, stiffen, or fuse together. Thus the heart has to work harder to pump blood through the valve
Stenosis
What is the most important congenital Structural Heart Disease issue to worry about?
congenital bicuspid Aortic valve
can lead to aortic aneurysm formation
what is Mitral Regurgitation
Back flow of blood from the left ventricle back into the left atrium during systole
what causes Mitral Regurgitation
MI of the papillary muscle
rheumatic heart, disease, endocarditis, dilated cardiomyopathy, and mitral annulus calcification(AGE)
Mitral Regurgitation is commonly caused by what
rheumatic heart disease
what is Mitral Valve Prolapse and what is it often referred to as?
“floppy” mitral valve
“degenerative” mitral valve disease
how would you hear Mitral Regurgitation
Possible S3
how would you hear Mitral Valve Prolapse
Mid-Systolic click
Mitral Stenosis is primarily caused by what?
rheumatic heart disease
Mitral Stenosis sounds like what on an exam
Low pitched DIASTOLIC murmur
Aortic Stenosis Usually caused by….
by progressive valvular calcification and degeneration
with age > 65.
Aortic Stenosis sounds like what
Systolic crescendo – decrescendo murmur throughout systole with radiation to the right carotid artery
what can you feel during you exam from Aortic Stenosis
Parasternal heave
Thrill
what can you feel during you exam from Aortic Stenosis
Parasternal heave
Thrill in the aortic position.
What is a thrill?
is a vibratory sensation on your hand
what is a Heave what does this suggest?
an upward push on your hand when you palpate the precordium
suggesting the presence of ventricular hypertrophy
What causes blood to flow from the Aorta back into the left ventricle during diastole?
Aortic Regurgitation
how does Aortic Regurgitation present on a PE
1) Soft aortic DIASTOLIC murmur
2) Wide pulse pressure
3) Pulmonary edema
what is the gold standard for diagnosis in regards to Structural Heart Disease
Echocardiography
What is definitive treatment of valvular heart disease
Surgical repair is the definitive treatment for valvular heart disease with either tissue or mechanic valve replacement
how would you treat Treat valvular heart disease
Treat symptomatically
Any new murmur must be referred to __, MEDADVICE if asymptomatic, ______ if symptomatic or unstable.
MO
MEDEVAC
