STEPUP Cardiovascular System: Ischemic Heart Disease - Chest Pain Flashcards
What is the cardiac differential diagnosis for chest pain?
1) Heart, pericardium, vascular causes
a) Stable angina, USA, variant angina
b) MI
c) Pericarditis
d) Aortic dissection
What is the pulmonary differential diagnosis for chest pain?
1) Pulmonary embolism (can have pain with pulmonary infarction)
2) Pneumothorax
3) Pleuritis (pleural pain)
4) Pneumonia
5) Status asthmaticus
What is the GI differential diagnosis for chest pain?
1) Gastroesophageal reflux disease (GERD)
2) Diffuse esophageal spasm
3) Peptic ulcer disease
4) Esophageal rupture
What is the chest wall differential diagnosis for chest pain?
1) Costochondritis
2) Muscle strain
3) Rib fracture
4) Herpes zoster
5) Thoracic outlet syndrome
What is the psychiatric differential diagnosis for chest pain?
1) Panic attacks
2) Anxiety
3) Somatization
What illicit drug is known to cause angina or MI?
Cocaine
What are life-threatening causes of chest pain that you should first rule out upon presentation?
1) Acute MI
2) USA
3) Aortic dissection
4) Pulmonary embolus
5) Tension pneumothorax
6) Esophageal rupture
In ruling out life-threatening causes of chest pain, what should you obtain from the patient?
1) Assess vital signs
2) Develop a focused history
3) Perform a focused physical examination, with attention to cardiopulmonary, abdominal, and musculoskeletal examination
4) Order ancillary tests
5) Develop a diagnosis
What should you be asking a patient when developing a focused history for chest pain?
1) Character of the pain (pressure, squeezing, tearing, sharp, stabbing ,etc.)
2) Location of pain
3) Severity of pain
4) Duration of pain
5) Setting in which pain occurred (during exertion, at rest, after meal)
6) Radiation of pain
7) Aggravating or alleviating factors (e.g. meal, exertion, rest, respiration)
8) Does the patient have a cardiac history? Ask about results of previous stress tests, echocardiograms, cardiac catheterization, or of any procedures (PCI or CABG)9) If the patient has a history of angina, ask how this episode differs from previous ones (more severe? longer duration?)
What ancillary tests should be ordered for chest pain?
1) Obtain ECG in almost all cases
2) Cardiac enzymes (CK, CK-MB, troponin) depending on clinical suspicion
3) Obtain chest radiograph (CXR) in almost all cases
4) Under appropriate clinical setting, work up the patient for pulmonary embolism (PE)
What question should you ask yourself when trying to distinguish between GI causes of chest pain and angina? What should you do if the patient is young and without risk factors? What should you do if the patient is older and has risk factors?
1) It can be difficult to distinguish between GI causes of chest pain and angina. The decision of whether to initiate a cardiac workup is dependent on a patient’s overall risk of CAD and the clinical presentation
2) If the patient is young and without risk factors, treat for GERD and follow up if pain recurs (Anxiety may be a cause but is difficult to diagnose and usually only considered after ruling out cardiac causes first)
3) An older patient with risk factors should undergo a cardiac workup
Is there a fail-proof algorithm for approaching chest pain? In general, what populations should you have a greater index of suspicion for ischemic causes of chest pain?
1) No
2) Elderly, diabetic populations, and those with a history of CAD
What treatment is appropriate for a patient if you suspect a cardiac cause of chest pain? What else should you give this patient if the patient does not have a bleeding disorder?
1) Sublingual nitroglycerin
2) Aspirin
What are the most common cause of noncardiac chest pain that presents in the ED?
Gastrointestinal disorders
If nitroglycerin relieves the chest pain, what type of cause for the chest pain is more likely?
Cardiac cause, although esophageal spasm is still a possibility
