SIMPLE 01: Acute MI

Question 1

cardiac causes of chest pain

Answer 1

• (Un)Stable angina
• Acute MI
• Atypical/variant angina (coronary vasospasm, Prinzmetal’s)
• Cocaine-induced
• Pericarditis
• Aortic dissection: tearing, radiating to back
• Valvular disease, i.e., critical aortic stenosis
• Aarrhythmia

Question 2

list GI causes of chest pain

Answer 2

• Esophageal disease (GERD, esophagitis, esophageal dysmotility)
• Biliary disease (cholecystitis, cholangitis): typically RUQ with radiation to shoulder, may be referred to chest
• Peptic ulcer disease
• Pancreatitis

Question 3

list pulmonary cause of chest pain

Answer 3

• Pneumonia
• Spontaneous pneumothorax
• Pleurisy
• Pulmonary embolism
• Pulmonary hypertension/cor pulmonale
• Pleural effusion

Question 4

list musculoskeletal causes of chest pain

Answer 4

• Costochondritis
• Rib fracture
• Myofascial pain syndromes
• Muscular strain
• Herpes zoster

Question 5

list psychogenic causes of chest pain

Answer 5

• Panic disorders
• Hyperventilation
• Somatoform disorders

Question 6

associated symptoms to ask about in chest pain patients?

Answer 6

dyspnea, diaphoresis, syncope, dizziness/fatigue, nausea, abd discomfort, belching, indigestion

Question 7

classic ekg finding in pericarditis?

Answer 7

diffuse concave-upward ST segment elevations and a depressed PR segment. However, these findings are often transient and may not be present at all.

Question 8

typical pain history for pericarditis?

Answer 8

constant, worsened with inspiration, alleviated w/ position change (supine ->sitting and leaning forward)

Question 9

EKG findings in pulmonary embolism?

Answer 9

• Most common but less specific: sinus tach and nonspecific S-T and T-wave ∆s
• Less common but more specific: S1Q3T3 (S wave in lead one, Q wave in lead three and inverted T-wave in lead three), transient RBBB, and T-wave inversions in V1-V4.

Question 10

Official Dx criteria for MI?

Answer 10

Rise and fall of troponin or CK-MB plus ONE of:

Sx c/w M.I.
EKG ∆s of ischemia (ST elev or depr)
New pathologic Q waves
Findings on PCI

Question 11

How do you differentiate unstable angina from NSTEMI?

Answer 11

Whether the troponins increase, need serial troponins. Remember, no troponin increase = No MI.

Question 12

Pt w/ chest pain and new LBBB should be triaged as a patient having ____?

Answer 12

a STEMI

Question 13

How do you decided which NSTEMI pts should get PCI?

Answer 13

Use TIMI score:
—Age ≥65 years
—≥3 risk factors for CHD (HTN, DM, dyslipidemia, smoking, or FMHx of early MI)
—Prior coronary stenosis ≥50%
—Presence of ST deviation on admission ECG
At least two anginal episodes in prior 24 hours
Elevated serum cardiac biomarkers
Use of aspirin in prior seven days (which is probably a marker for more severe coronary disease)