Step 2 CK Flashcards
GI disorders associated with chest pain
ulcer disease, cholelithiasis, duodenitis, gastritis
Benefit a pt risk of coronary disease
Exercise. Increase heart rate shows clear benefit in cardiac outcome
CAD risk factors
DM, smoking, HTN (140/90), HL, FMH of premature CAD, men>45, women >55
Tako-Tsubo cardiomyopathy
acute myocardial damage most often occur in post menopausal women immediately after an overwhelming event or news (stress). Leads ballooning and left ventricular dyskinesis.Manage with ACE and Beta blockers. Revacularization will not help because coronary arteries (angiography) are normal
Ischemic pain
dull or sore; squeezing or pressure
3 features of CP tell whether or not the pain is ischemic in nature
- changes with respiration (pleuritic)
- changes with the position of the body
- changes with touch of the chest wall (tenderness)
Costochondritis
chest wall tenderness
Test: PE
Pericarditis
pain worse with lying flat, better sitting up, young (<40)
Test: ECG with ST elevation everywhere, PR depression
Aortic dissection
radiation to the back, unequal bld pressure between arms
Test: Chest Xray with widened mediastinum, chest CT, MRI, TEE confirms disease
Duodenal ulcer
epigastric discomfort, better when eating
test: endoscopy
GERD
bad taste, cough, hoarseness
Test: response to PPIs or antacids (aluminum hydroxide and magnesium hydroxide)
Pneumonia
cough, sputum, hemoptysis
test: CXR
PE
sudden onset of SOB, tachycardia, hypoxia
Test: spiral CT, V/Q scan
Pneumothorax
sharp, pleuritic chest pain, tracheal deviation
test: CXR
Ischemia EKG
ST depressions
best methods for detecting ischemia w/o the use of EKG because of a baseline abnormality
- nuclear isotope uptake or sestamibi
2. ECG detection of wall motion abnormalities
Reasons for baseline EKG abnormalities
left bundle branch block, left ventricular hypertrophy, pacemaker use, or the effect of digoxin
Exercise tolerance
determine presence of ischemia
ST segment depression
Exercise thallium
normal myocardium will pick up thallium in the same way that potassium is picked up by Na/K ATPase.
ischemia will have decrease uptake of nuclear isotope