1 Chest Pain Flashcards
For patients with any abrupt, new, or severe chest pain, obtain an ECG within
10 minutes
For chest pain patients, administer oxygen if ambient saturation is
<94%
Nonclassic presentaitons ofr ACS occur more frequently in
Psychiatric patients
Altered mental status
Women
Diabetics
Elderly
Racial minorities
In these patients, include an ECG in routine evaluation of abdominal pain
Patients >50 y/o
Or those with known CAD
What is Boerhaave’s syndrome
Esophageal rupture
Classically presents with a history of sudden-onset sharp substernal chest pain following forceful vomiting.
When suspecting esophageal rupture, obtain a CT with oral-water soluble contrast
This refers to audible crepitus that varies with the heartbeat on auscultation of the precordium
Hamman’s crunch
A rare finding associated with pneumomediastinum.
Most specific physical examfinding for pericarditis
pericardial friction rub
chest pain of pericariditis
Worst with supine
Worsened by inspiration
Relieved by sitting and leaning forward
Classic ECG findings in pericarditis
Diffuse ST-segment elevation with PR depression
What is another name for costochondritis
Tietze syndrome
Panic disorder is characterized by:
recurrent, unexpected, and discrete periods of intense fear or discomfort with at least 4 of the following symptoms:
chest pain
dyspnea
palpitations
diaphoresis
nausea
tremers
choking
dizziness
fear of losing control
fear of dying
paresthesia
chills
hot flashes
Remarks with panic disorder
Do not assume panic disorder in a patients with chest pain in the ED until further testing allows better risk stratification.
Some conditions with elevated cardiac troponin levels in the absence of ischemic heart disease
Pulmonary hypertension
Arrhythmias
Pulmonary embolism
Aortic dissection
Burns
Extreme exertion (e.g., endurance athletes)
Acute neurologic disease (e.g., stroke, SAH)
Respiratory failure
Sepsis
In the setting of renal failure, elevation of ______ is more common than troponin I elevation
Troponin T
Patients with renal disease often have an elevated troponin T (15-50%), whereas Troponin I eleveations are less common (<10%)