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CP II - Beck > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What are the three most common causes of chest pain? Least common?

A

MSK Conditions, nonspecific chest pain, GI disease, Stable CAD
**Least Common: Unstable CAD

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2
Q

What is the prevalence of acute coronary syndrome in a walk in primary care office?

A
  1. 5%

1. 5 patients out of 100 of chest pain patients in primary care medical office have unstable heart disease

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3
Q

What indicators should trigger a call for an ambulance for a patient with chest pain?

A

Chest pain + respiratory distress or abnormal vital signs including erratic pulse or low BP

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4
Q

What associated symptoms should you ask a patient with chest pain? (3)

A

Confusion
Restlessness
Combination of dyspnea, palpitations, sweating

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5
Q

MFTPs in what muscles are most likely to mimic the pain associate with cardiac angina?

A

Scalenes
Pec major/minor
Serratus anterior

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6
Q

What are the top 3 clues that would suggest that a patient’s chest pain is not cardiac in origin?

A

Pain that is pleuritic - tied to breath cycle. Deep breath in = sharp pain

Pain that is positional

Pain that is reproducible with palpation ** this might be the best of the 3

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7
Q

What special ancillary tests are options for the initial round of testing patients for cardiac angina?

A

Resting EKG
Stress tests (3 types)
Chest radiograph
Angiography

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8
Q

What is the gold standard test?

A

Angiography is gold standard

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9
Q

How does the CAC test fit into a cardiac assessment?

A

Coronary artery calcium (CAC) test checks the number of calcium in your arteries. They do a CAT scan and measure amt of calcium build up in your coronary artery. More calcium = more risk. It’s expensive and many insurance companies don’t pay for it.

NOT a blood test, its a special CT scan.

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10
Q

What are other (5) risks for coronary artery disease derived from the patient’s history and physical?

A

1 Male
2 Family history
3 Increased hsCRP (highly sensitive chronic inflammation marker)
4 HRT (hormone replacement therapy)
5 Increased CAC (coronary artery calcium)

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11
Q

What blood tests are ordered to assess risk factors for coronary artery disease?

A

Lipid profile: HDL, LDL, total cholesterol
Glucose or Hgb A1C
hsCRP (highly sensitive)

**NOT a blood test: CAC

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12
Q

What is the classic triad of findings that suggest typical angina?

A

Substernal chest discomfort with a characteristic quality and duration

Provoked by exertion or emotional stress

Relieved by rest or nitroglycerin

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13
Q

What is a cardiac red flag

A

Chest pain that completely stops a patient from activity

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14
Q

What are clues from the history that increase the probability of acute MI (in order from highest to lowest LR)

A

Nausea
Both arms with pain
Right arm pain

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15
Q

What are tests are done in the ED to Dx MI?

And which tests shows permanent damage?

A

EKG
Troponins
Cardiac enzymes

Damage shown on EKG is permanent because that’s testing the cardiac muscle cell death

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16
Q

How are troponins tested?

A

Blood draws: takes 2-3 hours to show up in the blood, they peak around 12 hours and in 24 hours they’re gone

Cardiac enzymes CPK-MB follows the same pattern but is not recommended anymore but good board Q

17
Q

What serious risk can arrhythmias subject a patient to?

A

Stroke or peripheral embolism

19
Q

What are some of the common symptoms associated with arrhythmias?

A

1 - Irregularly irregular pulse
2 - Commonly tachycardic 110-140 beat/min

Also: palpitations, dyspnea, fatigue, dizziness, angina, and decompensated heart failure.

In addition, atrial fibrillation can be associated with hemodynamic dysfunction, tachycardia-induced cardiomyopathy, and systemic thromboembolism.

20
Q

What percentage of arrhythmias are asymptomatic

A

90%

21
Q

How does angina present?

A

Substernal chest pain with characteristic quality and duration

Provoked by stress, relieved by rest or nitro

22
Q

What follow up tests should be ordered for angina

A

12 lead resting EKG
Stress tests (EKG, stress echocardiogram, myocardial perfusion scintigraphy)
Chest radiograph
Gold standard: angiography

23
Q

What are the 3 stress tests?

A

EKG
Stress echocardiogram
Myocardial perfusion scintigraphy

24
Q

Describe stress echocardiogram

A

US after the stress test

25
Q

Describe myocardial perfusion scintigraphy

A

injection tagged with radioactive material and then the material will perfuse through the heart muscle. If coronary arteries are clogged and you do the stress test, those parts of the heart would not absorb the dye and so you think there is no blood there, aka its blocked.

26
Q

What are big clues that suggest pericarditis

A

1 - non-pleuritic friction rub (sound of crackling like rubbing hair on pinnae of ear) so have them hold their breath and see if the sound goes away, then it is from the lungs. If it doesn’t go away, then it is from the heart
2 - precordial pain that radiates to trapezius ridge
3 - aggravated by supine posture, relieved by bending forward ***know this. So chest pain is worse when their heart rests toward their back and is better leaning forward.
4 - characteristic ECG/EKG electrocardiogram

27
Q

P aggravated by supine posture, relieved by bending forward. What might this be?

A

Pericarditis

When their heart rests toward their back, the pain is worse and better when they lean forward.

28
Q

What is a big clue for valvular disease?

A

Mid systolic murmur or closing click

29
Q

What is a mid systolic murmur?

A

Lub swish dub

30
Q

What is a closing click

A

Click dub

31
Q

What ancillary study should be ordered for a valvular disease?

A

Stress Echocardiogram

32
Q

Big clues for pleuritis?

A

Pleuritic pain, respiratory friction rub, fever/malaise

33
Q

What follow up studies would you do for pleuritis?

A 
Chest radiograph
CBC
Blood chem
ESR
ANA
34
Q

What is a general test for lupus?

A

ANA

37
Q

What arrhythmias required urgent/emergent medical referral?

A

Lower chamber - ventricular tachycardia and ventricular fibrillation

CP II - Beck (5 decks)

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