22. Chest Pain Flashcards
(47 cards)
6 catastrophic causes of CP
-acs<br></br>-ao dissection<br></br>-PE<br></br>-pneumothorax <br></br>-pericardititis with tamponade<br></br>-esoph rupture
Radiation of pain is often caused by somatic __ fibers synapsing in the same ? as the thoracic viscera
afferent<br></br>dorsal root ganglia
DDX of CP by organ system:<br></br>CV<br></br>a. critical dx - 4
acute MI<br></br>acute coronary ischemia<br></br>ao dissection <br></br>cardiac tamponade
DDX of CP by organ system:<br></br>cv<br></br>b. emergent dx - 4
unstable angina<br></br>coronary spasm<br></br>prinzmetal angina<br></br>cocaine induced peri or myocarditis
DDX of CP by organ system:<br></br>cv<br></br>c. nonemergent dx - 4
valvular heart dis<br></br>ao stenosis<br></br>MVP<br></br>HOCM
DDX of CP by organ system:<br></br>Pulmonary <br></br>a. critical dx - 2
-PE<br></br>-tension pneumothorax
DDX of CP by organ system:<br></br>Pulmonary <br></br>b. emergent dx - 2
ptx<br></br>mediastinitis
DDX of CP by organ system:<br></br>Pulmonary <br></br>c. nonemergent -4
pneumonia<br></br>pleuritis<br></br>tumor<br></br>pneumomediastinum
DDX of CP by organ system:<br></br>GI<br></br>a. critical - 1
Esophageal rupture/Boerhaave syndrome
DDX of CP by organ system:<br></br>GI<br></br>b. emergent dx - 3
esophageal tear (MW tear)<br></br>Cholecystitis<br></br>Pancreatitis
DDX of CP by organ system:<br></br>GI<br></br>c. nonemergent dx - 4
-esophageal spasm<br></br>-esophageal reflux<br></br>-Peptic ulcer<br></br>-Biliary colic
DDX of CP by organ system:<br></br>MSK<br></br>c. nonemergent (only category): 6
-m strain<br></br>-rib #<br></br>-tumor<br></br>-arthritis<br></br>-costochondritis<br></br>-nonsp chest wall pain
DDX of CP by organ system:<br></br>Neuro<br></br>c. all nonemergent - 4
spinal root compression<br></br>thoracic outlet<br></br>herpes zoster<br></br>postherpetic neuralgia
DDX of CP by organ system:<br></br>Other - two nonemergent
psych<br></br>hyperventil
Best test for critical or emergent chest pain?
ecg
First steps assessing CP
- do i need to intervene now?<br></br>2. what is life threatening?<br></br>appearance, ecg, vitals
What signs/sx/dx would indicate emergent intervention with a needle or tube thoracostomy?<br></br>4
uni cp<br></br>resp distress<br></br>shock<br></br>uilat reduced or absence of breath sounds
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acs thoracic aortic aneursym esoph rupture PE
Initial MI 2 drugs (hint not for RV)
-aspirin<br></br>-ntg
pt with ao dissection and sign htn are candidates for immed reduction of what?
bp
patients w what signs should undergo prompt bedside pocus for pericardial tamponade?
low voltage ecg<br></br>diffuse ste<br></br>elevated JVP on exam<br></br>signs of shock
What key hx points lead you to believe cardiac ischemic syndrome?
squeeze<br></br>crush<br></br>pressure<br></br>can be bloat, indigestion
What key hx points lead you to believe ao dissection?
tear
What key hx points lead you to believe pulmonary or msk
sharp<br></br>stab
indigestion
but can be cv, pulmonary, msk
gi causes - esp pancreatitis, cholecystits, posterior ulcer
**inferoposterior mi can also manifest as thoracic back pain
-exertional but stops with rest = cardiac
-pain max onset = ao dissxn
-pain not sev, course of days typ less serious origin than that of stutter/fluctuating course
cv system
cardiac
Age men >33, wo >40
db
htn
cig use
elevated chol (LDL/TG)
sedentary
obese
post meno
LVH
cocaine abuse
prolonged immob ~4 hours
surgery >30 min in last 3 months
prev dvt/pe
pregn/rec pregn
pelvic/le trauma
OCP with smoking
chf
copd
obese
pmhx or fam hx hypercoagulable
congenital diseaes of aorta/aortic valve
inflamm aortic disease
ctd
pregn
arteriosclerosis
cig use
autoimm dis
ac rheumatic fever
recent mi or cardiac surgery
malign
radiation therapy to mediastinum
uremia
drugs
prior pericarditis
valsalva manuever
chr lung disease
cig use
narrow pp
new murmur
Hamman's sign
= esoph rupture or mediastinitis
JVD
cor ischem
tension ptx
pe
pericarditis
L vs R UQ tenderness
cholecystitis
ptx
pleural effusion
pulmonary edema
acs
pe
new injury
ao dissection
