Phase 2 EMED w/ Book Flashcards
Define Acute Chest Pain
This term includes ? two Dxs that are defined as ?
Recent onset of pain/pressure/tightness in anterior thorax between xyphoid, suprasternal notch and both mid-axillary lines
AMI: necrosis proven w/ elevated markers (classified into N/STEMI)
UA: chest pain/equivalent (neck/UE pain) from de perfusion w/ inc freq/less activity/at rest
What type of nerve fibers innervate the chest
What type of pain/description does these fibers offer
Somatic- chest wall from dermis to pleura
Enter spine at corresponding dermatome level= precise, easily described
Why/how does ACS present w/ referred pain
What words may be used to describe this type of pain stimulation
Visceral fibers map from spine to parietal cortex w/ corresponding somatic fiber
Vague, difficult
Discomfort Pressure Ache Tight Heavy
Pts presents w/ chest pain need to be in bed/on monitor/w/ EKG in ? min and add O2 if ?
What are the associated Sxs that can be present w/ these Pts
<10min
SPO2 <94%
Diaphoresis Dyspnea Dizzy N/V Palpitations
AMI Pts w/ pain located ? have 2x M/M risk increase
Define Classic Chest Pain
Pain out of chest cavity
Retrosternal, left anterior chest w/ Crushing Squeeze Tight Pressure that inc w/ exertion/improves w/ rest
Standard time limits for Anginal, UA and AMI pain
What are the “classic” ACS features?
A: 2-10min
U: 10-30min
AMI: >30min
Radiating Jaw/Arm/Neck pain
Diaphoresis
Dyspnea
N/V
Define “Non-Classic Chest Pain”
What populations are more likely to present with this
Pain lasting sec-hrs w/out wax/wane or worsened by movement
DM Psych Female AMS Minority Elderly
Pre/Early menopause females w/ non-classic chest pain are more likely to present w/ ? pain features
Female ACS associated Sxs
Male ACS associated Sx
Palpitations w/out pain
Unrelieved w/ Nitro/AAcids
Non-exercise related
C/C fatigue
N/V
Jaw/Neck/Back pain
Diaphoresis
MI + Diaphoresis= ? inc sudden death risk
Epigastric pain, even if relieved w/ AAcids, is suspicious for ACS especially in ? populations
How does this presentation change the Pts work up
4x than ASx
2x than classic angina
> 50y/o
Hx CADz
EKG for abdominal pain
Why is ACS considered for new palpitations
What are 3 RFs that can increase the rate of atherosclerosis leading to MI
Ischemia= inc automaticity, irritability leading to dysarrhythmia
Chronic cocaine
HIV/retroviral use
What Sxs are most strongly associated w/ ACS
How do MIs cause Tachy
How do MIs cause Brady
Pain radiating to arm/shoulder, worsened w/ exercise
Inc sympathetic tone, dec LVSV
Ischemia/infarct in conduction system altering activation to SA/AV node
AMI can present w/ ? murmurs
A new murmur can indicated ? two issues occurring
Ischemia induced heart failure will have ? PE finding
S3/S4
Dec S1
Paradoxical split S2
Aortic dissection
Ruptured tendonae
Crackles in lungs
What Sxs are most associated w/ AMIs?
? type of MI will benefit from rapid reperfusion efforts
HOTN S3 Dizzy
New ST elevation <1mm in two contiguous leads
What EKG finding indicates PTs are at risk for MI
What other conditions can present w/ ST elevations
ST depression w/ t-wave inversion
Peri/Myocarditis
LVH
Early Repol
Ventrical aneurysm
Define cardiac troponin marker
What marker is assessed for MIs in Pts w/ RF
When/why is BNP elevated
cTn: protein needed for contraction held by actin/myosin filaments in myocyte cytoplasm
cTnT, also inc after dialysis
Any ventricular dysfunction
