unit 1 noncardiac CP Flashcards
timing of mitral valve prolapse murmur?
pansystolic
or late systolic
what extra sound does mitral valve prolapse have? and what is the timing?
mid-systolic click
s/s of mitral valve prolapse? (3)
- CP
- dyspnea
- palpitations
if you see a patient with pectus excavatum what valvular disorder should you think of?
mitral valve prolapse
mitral valve prolapse effects men or women more?
women
physical characteristics AW pts at risk for mitral valve prolapse?
- healthy & thin
- marfan’s
- eherls danlos
psych hx AW mitral valve prolapse?
anxiety & depression
mitral valve repair is indicated if _______ is present
regurg
description of chest pain AW AA dissection?
- abrupt onset
- severe
- tearing/ripping
- radiate to back
risk factors for AA dissection (6)
- smoking
- cocaine
- inflammatory or collagen disease
- pregnancy
s/s AW AA dissection?
- ANXIETY
- BP higher 15+ pts R>L
- ABSENT UE PULSES
- HOLOSYSTOLIC MURMUR
- dyspnea
- hypo or hypertensive
timing of murmur AW AA dissection?
holosytolic (ST aortic insufficiency)
pericarditis CP location
- pleuritic, substernal
* radiates to epigastrium, shoulders, back
which non ischemic cause of CP is worse when supine?
pericarditis
what might you hear with pericarditis?
pericardial friction rub
s/s pericarditis
- fever
- dyspnea
- pain worse when supine
- pericardial friction rub
- pleuritic substernal CP radiates to epigastrium, shoulders, back
causes of pericarditis (5)
- VIRAL INFECTION
- POST-MI
- SLE/RA
- uremia
- CA
respiratory causes of CP (6)
- bronchitis
- PNA
- asthma
- COPD
- pleurisy
- PE
CP AW PNA & treatment of PNA
*dull or NO PAIN
CP and s/s AW PE
- pleuritic
- sharp
- stabbing
- UNILATERAL
- worse w deep breath or cough
- tachycardic
well score criteria is for?
PE
low wells score?
<2
criteria for wells score?
- clinical s/s of PE/DVT (3pts)
- PE #1 dx or equally likely (3pts)
- HR > 100 (1.5pts)
- immobilized x3d OR surg w/i past month (1.5pts)
- previous PE/DVT (1.5pts)
- hemoptysis (1pt)
- malignancy w treatment w/i 6mo OR palliative care (1pt)
high wells score?
> 6 = high suspicion- get CT & anticoagulate
s/s AW asthma CP presentation?
- fever
- cough
- wheezing
- dyspnea
what to assess in a pt w respiratory chest pain?
- fever
- egophony
- rales
- wheezes
- friction rub
top 3 noncardiac causes of CP
- MS
- GI
- psych
psych causes of CP
- stress
- panic attack
- somatization can aggravate GERD, asthma, angina
location of anxiety associated CP?
precordial
chest pain associated with depression?
- constant or intermittent
- HEAVINESS
- unrelated to meals/activity
- SUDDEN OR GRADUAL
associated symptoms with CP caused by psych
- anxiety
- dyspnea
- hyperventilation
- tingling/numbness in BILATERAL extremities
- dizziness
2 questions to screen pscyh associated CP
in the last 6mo have you
- had a spell or attack of feeling anxious?
- felt heart racing or felt faint?
GI disorders AW CP
- GERD
- esophagitis/spasm
- PUD
- hiatal hernia
- gallbladder
risk factors associated with GI related CP
- hx of ulcers
- smoking
- ETOH
- NSAIDS/asa
- always ask about OTCs
CP description of GI related pain
*substernal BURNING
s/s esophageal spasm related CP
- squeezing
* pressure
PUD associated pain location and timing
- epigastric radiating to back
- worse w meals
- worse when supine
epigastric pain with palpation would indicate what type of non cardiac cause of CP
GI
tests to run for GI related pain?
- H.pylori
* EGD
treatment of GI related CP
- PPI
- Abx if h.pylori
- dietary changes
- elevated HOB
causes of musculoskeletal related CP
- muscle strain
- costochonrditis
- broken rib
- herpes zoster
- fibro
- SSC (what??)
- chest wall contusion
- protracted vomiting
risk factors for MS related CP
- young, active
- trauma
- overuse
- hx chicken pox
location of MS related CP
- LOCALIZED
* pt can point to w one finger
s/s of MS related CP
- gradual onset
- sharp or dull
- localized
- worse w arm movement/deep inspiration
diagnostic testing for musc CP
none unless trauma
tx for musc CP
rest, NSAIDS, ice x24h then heat
