S7C52 - Chest Pain: Cardiac or Not

Question 1

Risk factors for Acute myocardial infarction

Answer 1

->40yo, male, post-menopausal, HTN, smoker, hypercholesterolemia, DM, truncal obesity, family history, sedentary lifestyle, cocaine

Question 2

Risk factors for aortic dissection

Answer 2

• atherosclerosis
• HTN
• coarcatation of the aorta
• bicuspid aortic valves
• aortic stenosis
• marfan syndrome
• ehlers-danlos
• pregnancy

Question 3

Causes of Chest wall pain

Answer 3

-costosternal syndrome
-costochondritis (tietze syndrome)
-precordial catch syndrome
-slipping rib syndrome
0xiphodynia
0radicular syndromes
-intercostal nerve syndromes
-fibromyalgia

Question 4

Causes of pleuritic pain

Answer 4

• PE
• PNA
• spontaneous pneumo
• pericarditis
• pleurisy

Question 5

8 Causes of life-threatening chest pain

Answer 5

• ACS
• PE
• aortic dissection
• esophageal rupture
• pneumothorax
• pericarditis
• pneumonia
• perforated peptic ulcer

Question 6

Esophageal rupture = boerhaave syndrome

Answer 6

• sudden onset sharp substernal chest pain usually after vomitting
• ill-appearing, dyspneic, diaphoretic
• CXR - may have pleural effusion (L>R), pneumothorax, pneumomediastinum, pneumoperitoneum, subcu air

Question 7

PCS - precordial catch syndrome

Answer 7

• short, lancinating chest pain
• episodic lasting 1-2min
• assoc with inspiration and poor posture and inactivity

Question 8

Esophageal Spasm

Answer 8

• assoc with GERD
• sudden onset dull, tight, gripping substernal c/p
• often precipitated by hot or cold liquids or a large food bolus
• lasts hours
• may disappear with SL nitro with a slight delay

Question 9

PUD

Answer 9

• duodenal ulcers are relieved by eating food

- gastric ulcers are exacerbated by eating

Question 10

Troponins

Answer 10

• troponin complex is a filament of myofibrils that regulate the Calcium dependent ATP hydrolysis of actomyosin
• subunit of 3 parts:
• troponin I = inhibitory
• troponin T = troponin-binding subunit
• troponin C = calcium-binding subunit
• troponin I and T can be detected in the serum 2h after an AMI, levels reach a peak at 12h and may stay elevated for 10d
• troponin T is more likely to be elevated in renal fialure

Question 11

Conditions with elevated troponins:

Answer 11

• ACS
• tachyarrhythmias
• LVH
• myocarditis
• pericarditis
• heart failure
• PE
• sepsis
• cardiac contusion, invasive procedures (pacing, ablation), dissection, Ao valvue disease, HOCM, rhabdo, pulm HTN, acute neuro dz (stroke, SAH), infiltrative dz (amyloid, sarcoid, hemochromatosis, scleroderma), drug toxicity, resp failure, burns, exertion

Question 12

BNP

Answer 12

• increases in serum due to increased ventricular wall tension and pressure over-load
• released as pro-BNP which is then cleaved to NTproBNP and BNP
• BNP reduces blood volume through natriuresis and decreases PVR via vasodilation to overall decrease afterload
• BNP half life is 20mins (degraded in blood stream), NTproBNP 1/2 life is 90 mins (excreted by kidneys)