Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Adult/Ped Medicine 4 > The Evaluation of Chest Pain in the Emergency Setting - Brown > Flashcards

The Evaluation of Chest Pain in the Emergency Setting - Brown Flashcards

1
Q

Pathogenesis of Chest Wall Pain

A
  • irritation
  • trauma
  • compression of structures
  • muscles
  • cartilaginous structures
  • nerves
  • bones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Gastroesophageal Reflux

*Describe the presentation and characteristics of gastrointestinal causes of chest pain *

A
  • substernal burning and pain
  • starts in epigastrium and radiates upward
  • related to consuming large meal, lying down, or bending over
  • relieved by antacid or food
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Treatment Algorithm: strongly suspicious for injury

A

start adjunctive treatments

  • B-adrenergic receptor blockers
  • nitroglycerine
  • heparin
  • ACE inhibitors

time from onset of symptoms

  • < 12 hours - select a reperfusion strategy
    • angiography
    • PCI
    • CT surgery
    • fibrinolytic therapy
  • > 12 hours - not candidate for fibrinolytics
    • treat as non-ST elevated AMI (cath, revascularization)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chest Pain - Musculoskeletal or Nerve Origin

Describe the presentation and characteristics of chest pain that is musculoskeletal or nerve origin

A
  • lasts few seconds to days, months, maybe longer
  • sharp, dull or aching
  • aggravated by deep breathing or cough
  • point-tenderness on palpation
  • may be dermatomal
  • occurs with movement
  • bone pain is well localized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Costochondritis

*Describe the presentation and characteristics of chest pain that is musculoskeletal or nerve origin *

A
  • sharp, well localized pain
  • most intesne at costochondral junction
  • palpation reproduces pain
  • warmth, erythema and swelling
  • aggravated by deep breathing and cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pulmonary Embolism

*Describe the presentation and characteristics of pulomonary causes of chest pain *

A

Risk Factors:

  • immobility
  • recent surgery
  • pregnancy or oral contraceptive use
  • large bone fracture
  • malignancy
  • DVT or prior PE
  • CHF
  • COPD
  • obesity
  • hypercoagulability

Presentation:

  • pleuritic chest pain
  • sudden onset dyspnea
  • tachypnea and tachycardia
  • hypotension
  • hemoptysis possible

Examination:

  • rales (crackles) and pleural friction rub
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Absolute Contraindications to Fibrinolytic Therapy

List the indications and contraindications for thrombolytic therapy

A
  • history of intracranial hemorrhage
  • known intracranial neoplasm or vascular lesions
  • active bleeding or known bleeding disorder
  • embolic stroke within 3 months
  • suspected aortic dissection
  • significant facial or head trauma within 3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Options for testing of CAD

A
  • treadmill - exercise tolerance test (ETT)
  • stress myocardial perfusion imaging
  • stress echo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

NSTEMI

Describe the classification of Acute Coronary Syndrome and the inital evaluation based upon 12-lead ECG findings

A
  • occluding thrombus sufficient to cuase tissue damage and mild myocardial necrosis
  • ECG:
    • can look normal
    • ST depression +/- T wave inversion
  • Elevated cardiac enzymes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

non-invasive testing for chest pain

Describe common non-invasive tests used to evaluate chest pain.

A
  • Electrocardiogram
  • Exercise Treadmill Testing
  • Stress Myocardial Perfusion Imaging
    • Nuclear stress testing
    • Pharmacologic stress
      • adenosine, dipyridamole, dobutamine
      • sestamibi
  • Stress Echocardiography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

History and Physical Exam of patients with Chest Pain

  • Describe the diagnostic evaluation of patients with chest pain including H & P, diagnostic tests, initial management and patient education*
A

History

  • if emergent brief targeted history, get more details later
  • OLD CHARTS

Physical Exam

  • asses level of stress and anxiety
  • BP in both arms (doppler if needed)
  • postural BP
  • skin
    • pallor, cyanosis
    • jaundice
    • herpes zoster rash
  • eyes - fundoscopic exam
  • neck
    • lymphadenopathy
    • thyromegaly
    • tracheal shift
    • JVD
    • carotid bruits
  • chest wall
    • signs of trauma
    • heaves or lifts
    • palpate for tenderness
  • complete heart exam
    • extra heart sounds
    • murmurs, clicks, hums, rubs
    • irregularities
    • arrhythmias
  • lungs
    • equal breath sounds, plerual rub
    • crackles
    • ronchi
    • wheezes
  • Abdomen
    • bowel sounds and bruits
    • tenderness, masses
    • organomegaly
    • ascitis
  • Lower Extremities
    • femoral and peripheral pulses
    • cyanosis
  • Musculoskeletal and Neurological
    • patients with pain on motion
    • focus on focal tenderness
    • motor or sensory deficits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cardiopulmonary or Vascular Differential Diagnosis of Chest Pain

Give a broad differential diagnosis of chest pain listed by organ system.

A
  • MI
  • Aortic Dissection
  • Pericarditis
  • Pulmonary Embolism
  • Valvular Disease
    • Aortic Stenosis
    • Mitral Valve Prolapse
  • Bacterial Endocarditis
  • Hypertrophic Obstructive Cardiomyopathy
  • Myocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Classification of Acute Coronary Syndromes

Describe the classification of Acute Coronary Syndrome and the inital evaluation based upon 12-lead ECG findings

A
  • Unstable angina pectoris
  • non-ST segment elevation MI (NSTEMI)
  • ST segment elevation (STEMI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pleural Causes of Chest Pain

Describe the presentation and characteristics of chest pain that is pleural in origin

A
  • worsened by deep inspiration or coughing
  • spasm secondary to:
    • cold weather
    • increased activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

gastrointestinal causes of chest pain

give a broad differential diagnosis for chest pain listed by organ system

A
  • Gastroesophageal reflux
  • Esophageal spasm
  • Cholecystitis
  • Peptic ulcer disease
  • Pancreatitis

GI Disorders are associated with eating, relief with antacids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fibrinolysis Indications

List the indications and contraindications for thrombolytic therapy

A
  • ST segment elevation > 1 mm in two contagious leads
  • new LBBB
  • symptoms consistent with ischemia
  • symptom onset less than 12 hours prior to presentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Unstable Angina

Describe the classification of Acute Coronary Syndrome and the inital evaluation based upon 12-lead ECG findings

A
  • non-occlusive thrombus
  • ECG: non-specific ECG; ECG can look normal
  • normal cardiac enzymes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nerve Root Compression

Describe the presentation and characteristics of chest pain that is musculoskeletal or nerve origin

A
  • results in pain and motor/sensory deficits
  • numbness or tingling in neck, chest, upper arm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

AMI Symptoms in African Americans

A
  • abdominal pain
  • absence of chest pain
  • dizziness/weakness
  • fatigue
  • hot and flused
  • indigestion
  • palpitations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

AMI Symptoms in the Elderly

A
  • absence of chest pain
  • diaphoresis
  • dyspnea
  • faintness
  • syncope
  • nausea
  • vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diagnostic Testing in patients with Chest Pain

Describe the diagnostic evaluation of patients with chest pain including H & P, diagnostic tests, initial management and patient education

A

based on the data from the H &P

  • pulse oximetry
  • cardiac enzymes
  • CBC and complete metabolic panel
  • 12 lead ECG
  • chest x ray
  • others to consider
    • echocardiogram
      • mitral valve prolapse
      • valvular disorders
    • aortic aneurysm or dissection
      • CT with contrast
      • TE echo
      • aortic angiography
    • cardiac catheterization
    • stress echo
    • spiral CT
      • pulmonary embolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

“Atypical” Chest Pain

A
  • doesn’t fit a common pattern
  • no abnormal exam or diagnostic findings
  • usually self-limited and resolves on own
  • diagnosis of exclusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

AMI Symptoms in Women

A
  • absence of chest pain
  • nausea
  • vomiting
  • hypotension with tachycardia
  • right arm, neck, jaw pain
  • back pain
  • dyspnea
  • headache
22
Q

Treatment Algorithm: suspicious for ischemia

A
  • NOT candidates for fibrinolytic therapy
  • Adjunctive treatment
    • heparin
    • aspirin
    • glycoprotein receptor inhibitors
    • nitroglycerin
    • B-adrenergic receptor blockers
  • Assess clinical status
    • ischemia
    • depressed LB function
  • condiser cardiac cath and revascularization
22
Pathogenesis of gastrointestinal problem chest pain
Structural Defects * lumen laxity * obstruction * distension Mucosal or organ irritation, inflammation or infection * esophagus * abdominal organs
23
*Describe the presentation and characteristics of _psychiatric_ or _mental disorder_ causes of chest pain *
* Psychogenic Chest Pain * generalized, constant * aggravated by any effort * present in times of stress, absent at non-stress time * Associated Symptoms * Dyspnea * Fatigue * Headache * Hyperventilation * somatic symptoms
25
Spontaneous Pneumothorax *Describe the presentation and characteristics of pleural causes of chest pain*
* secondary to trauma or disease * more common in: young men, smokers, COPD * pain pattern * acute unilateral, stabbing pain * dyspnea * examination * decreased breath and voice sounds \*\* beware of mediastinal shift and Tension Pneumothorax
26
Myocardial Infarction *Describe the characterisitics of chest pain due to various cardiac conditions*
* chest pain * other symptoms * dyspnea * diaphoresis * anxiety * palpitations * nausea * vomiting * lasts 20-30 minutes or longer * unrelieved or only partial relief with nitro or MS
27
Mitral Valve Prolapse *Describe the characterisitics of chest pain due to various cardiac conditions*
* patients are asymptomatic; symptoms may occur (15%) * chest pain - sharp, not relieved by nitro, unrelated to exertion * fatigue * shortness of breath * palpitations when lying on left side * lightheadedness * dizziness * hedache * mood swings * auscultatory feature: * midsystolic click or multiple clicks * midsystolic to late systolic murmur at the apex of left ventricl over teh mital area
28
Chest Pain due to Cardiac Disease
* mild to severe * transient, exertional pain * often radiates to jaw or arms * may be associated with * weakness * dyspnea * diaphoresis * nausea * vomiting * palpitations * anxiety
29
Plan and Management in patients with Chest Pain *Describe the diagnostic evaluation of patients with chest pain including H & P, diagnostic tests, initial management and patient education*
Pain relief - nitro or MS - relieve to a 0 of 10 Ischemic Heart Disease/Acute Coronary Syndrome * thrombolytic therapy * cardiac cath Other cardiac or pulmonary problems * treatment based upon establishing diagnosis Psychogenic Problems * reassurance * appropriate referral
29
Factors that Increase Risk of AMI
* hypotension * tachycardia * pulmonary crackles * JVD * pulmonary edema * new murmurs * heart sounds * diminished peripheral pulses * signs of stroke
30
Diagnosis of STEMI/NSTEMI
2 of the following * ischemic symptoms * diagnostic ECG changes * serum cardiac marker elevation * wall motion abnormalitiy on echo
31
AMI Symptoms with Comorbidities | (Diabetes, Heart Failure)
* Diabetes * silent MI * Heart failure * less likely to have CP * may have atypical symptoms
32
Cardiac Care Goals
* decrease amount of myocardial necrosis * preserve LV function * prevent major adverse cardiac events * treat life threatening complications
34
Dissecting Aortic Aneurysm *Describe the characterisitics of chest pain due to various cardiac conditions*
pain: * excruciating, tearing, knifelike pain; sudden onset, lasts hours * anterior chest * may be abdomen or back pain * often radiates to thoracic back risk factors: * hypertension * connective tissue disease * pregnancy * arteriosclerosis * cigarette smoking common signs: * lowered or elevated BP - widened pulse pressure * dissociation of arm BP * absent pulses * paralysis * pulsus paradoxus * aortic insufficiency murmur
35
Mechanical and Revascularization Therapy for Ischemic Heart Disease
* Coronary Angioplasty * Percutaneous Interventions - balloon angioplasty, stent placement * CABG - Coronary Artery Bypass Grafting * Enhanced External Counterpulsation
36
Cocaine-Induced Chest Pain *Describe the presentation and characterisitcs of chest pain that is non-cardiac.*
* severe, sharp, pressure-like or squeezing substernal pain * associated symptoms * euphoria * mydriasis * hyperstimulation * paranoia * delusions * nausea * muscle twitching * depression * complications * myocardial ischemia and infarction * arrythmias * respiratory failure * circulatory collapse
38
Panic Disorder *Describe the presentation and characteristics of psychiatric or mental disorder causes of chest pain *
chest pain with intesne fear * tachypnea * palpitations * diaphoresis * trembling * nausea * dizziness * syncope or near syncope * chills or hot flashes
39
STEMI Cardiac Care
Assessment * Time since onset: 90 minutes for PCI/ 12 hours for fibrinolysis * Determine if fibrinolysis candidate * \< 3 hours from onset * PCI unavailable or delay * if no contraindications * door to needle goal \< 30 minutes * Determine if PCI candidate * if available * door to ballon \< 90 minutes * if fibrinolysis is contraindicated * late presentation \> 3 hours * STEMI is in doubt
40
Education for patients with Chest Pain *Describe the diagnostic evaluation of patients with chest pain including H & P, diagnostic tests, initial management and patient education*
* cardiology consult if indicated * cardiovascular risk reduction * recognition of cardiac chest pain - seek medical attention 911 * proper use of medication * nitro for angina * other prescribed meds
41
Pericarditis *Describe the characterisitics of chest pain due to various cardiac conditions*
* Paroxysmal pain * Pain decreased with sitting and leaning forward * **Friction Rub** * May be associated with: * fever * tachycardia * pulus paradoxus * cardiac tamponade * elevated ESR and leukocytosis * Risk factors: infection, autoimmune disease, recent MI, cardiac surgery, malignancy uremia
42
Pathogenesis of lungs and adjacent structures chest pain
* irritation/inflammation of lung tissue, pleura, diaphragm * infection * chronic disease * neoplasm * reactive airway/bronchospasm
43
Relative Contraindications to Fibrinolytic Therapy *List the indications and contraindications for thrombolytic therapy*
* uncontrolled severe hypertension * prolonged cardiopulmonary resuscitation or recent surgery or noncompressive vascular puncture * current anticoagulation * streptokinase * prior exposure to the drug * hx of allergic reaction
44
Pathogenesis of Cardiac Chest Pain
* low-flow states of myocardium (CAD) * spasm * tissue hypoxia * anaerobic metabolism * lactic acidosis
46
Angina Pectoris *Describe the characterisitics of chest pain due to various cardiac conditions*
* Usually lasts less than 10 minutes * Relieved by rest or with nitroglycerine
47
Pleural Effusion *Describe the presentation and characteristics of chest pain that is pleural in origin*
* Transudates * congestive heart failure * acute atelectasis * pulmonary embolism * Exudates * pneumonia * cancer
48
Bacterial Pneumonia *Describe the presentation and characteristics of chest pain that is pleural in origin*
* most common cause of pleuritic pain * fever * chills * cough * leukocytosis * localized physical exam - chest x-ray findings
49
* Emergency Department approach to a patient presenting with chest pain* * initial assessment and life-saving treatment of chest pain patients in the ED*
RULE OUT greatest life threat first Treat to prevent potential complications Intitial Assessment * measure vital signs * measure oxygen saturation * obtain IV access * administer O2 * monitor Brief, targeted H&P * eligibility for fibrinolytic therapy Initial Diagnositc Studies * 12-lead ECG * serum cardiac marker levels * electrolytes and coagulation studies * portable CXR Targeted Phsyical * vitals * cardiovascular system * respiratory system * abdomen * neurological status Emergent Care * aspirin * nitrates
50
AMI Symptoms in Hispanics
* abdominal pain * chest pain * cough * cramping or burning chest pain * palpitations * upper back pain
51
Treatment Algorithm: NOT unstable angina and troponin is negative
* if further evidence of ischemia or infarction * persistent symptoms * depressed LV function * consider cardiac catheterization * anatomy suitable for revascularization: PCI, CABG
52
Pharmacologic Management - Therapy for Ischemic Heart Disease *List common classes of drugs used to treat chest pain in the emergency setting*
* Nitrate Therapy * Sublingual PRN * Chronic therapy: oral/transdermal * Emergency: IV * B-Blockers * Ca Channel Blockers * Antiplatelet Agents * Aspirin * Clopidrogrel (Plavix)
53
STEMI *Describe the classification of Acute Coronary Syndrome and the inital evaluation based upon 12-lead ECG findings*
* complete thrombus occlusion * ECG: * ST elevations on ECG or new LBBB * cardiac enzymes: elevated
54
Pathogenesis of psychogenic disorder chest pain
* secondary to anxiety, depression, other psych disorder * illicit drug use
55
Esophageal Spasm *Describe the presentation and characteristics of gastrointestinal causes of chest pain *
* intesne, substernal, sharp pain * may radiate to interscapular region * may be relieved by nitroglycerine

Adult/Ped Medicine 4 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions