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Surgery > Emergency Medicine - Chest Pain > Flashcards

Emergency Medicine - Chest Pain Flashcards

0
Q

unstable angina

A

new in onset, occurs at rest or is similar but somewhat “different” than previous episodes

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1
Q

stable angina

A

transient, episodic chest discomfort, predictable, reproducible

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2
Q

substernal chest discomfort >15mins, dyspnea, diaphoresis, LH, palps, N/V

A

acute MI –> STEMI or NSTEMI

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3
Q

what is the PE of someone with ACS like?

A

usually nl, 15-20% pts with MI have S3, 15% with ACS have chest wall TTP

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4
Q

CK-MB

A

elevate at 3-12 hrs after MI, peak at 18-24hrs, duration 2d

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5
Q

troponins

A

Tn-I similar to CK-MB (elev 3-12hrs) but duration longer (5-10d)
TN-T less sensitive for myocardial injury but indep marker of CV risk

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6
Q

TX of ACS

A

OH BATMAN! oxygen, heparin, BB, aspirin, thrombolytic, morphine, anti-platelet agent, nitrates

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7
Q

how do nitrates function

A

decrease preload and afterload, increase coronary perfusion

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8
Q

indications for fibrinolytics

A

ST elev >0.1mV in 2+ continuous leads or new LBBB and time to therapy <12hrs (class I), 12-24hrs (class II)

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9
Q

what test is most useful in cocaine-related chest pain?

A

Tn-I. ECG and CK-MB less sens for MI

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10
Q

tx of cocaine related chest pain

A

benzos, avoid BB

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11
Q

Sx if Ao dissection involves carotid arteries? spinal arteries? AA/renal arteries/iliacs?

A

stroke. paraplegia. abdominal/flank pain.

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12
Q

Sx if Ao dissection involves coronary arteries

A

aortic insufficiency, pericardial effusion/tamponade

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13
Q

Ao dissection + hoarseness

A

laryngeal nerve compression

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14
Q

Ao dissection + dyspnea/stridor/wheeze

A

tracheal compression

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15
Q

Ao dissection + dysphagia

A

esophageal compression

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16
Q

type A dissection. risks?

A

ascending Ao +/- descending Ao. >50yo with HTN.

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17
Q

type B dissection. risks?

A

descending Ao only. younger pts with marfans, ehler-danlos, pregnancy

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18
Q

Tx ao dissection. goals?

A

2 large bore IVs, monitor, ECG, IV nitroprusside + esmolol or labetolol to achieve goal SBP 90-100mmHg, HR 60-80. early CT surgery involvement

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19
Q

CXR findings in Ao dissection (4)?

A

widened mediastinum, L pleural effusion, indistinct Aortic knob, displaced calcified intima >6mm from outer Aortic wall

20
Q

P pulmonale on ECG

A

sign of RA enlargement, peaked P in II >2.5mm height. may see in PE

21
Q

tx of PE

A

high pretest probability: heparin 80U/kg IV bolus then 18U/kg/hr IV drip then other study.
Low or intermediate pretest probability: study first then anticoag if need. consider thrombolytics if unstable.

22
Q

tx of TPx and non-tension pnx

A

TPx - immediate needle decompression then chest tube; non-tension - upright PA CXR.

tube thoracostomy, catheter asp, obs x6hrs with repeat CXR if stable, minimal/no sx, no sig comorbs

24
Q

Which abnormal heart sound is most associated with Acute MI?

A

S3 (15-20%)

25
Q

What is the best diagnostic test for chest pain in the ED to identify Acute MI?

A

EKG

26
Q

Which cardiac biomarker is less sensitive for cardiovascular injury? Which cardiac biomarker has the longest duration?

A

Troponin-T. Troponin-T.

27
Q

CK-MB sensitivity for MI at presentation? Sensitivity 6 hours later?

A

50%. 90%.

28
Q

How does aspirin help treat Acute MI?

A

Decreases platelet aggregation by inhibiting thromboxane A2.

29
Q

How do nitrates help treat Acute MI?

A

Decreases preload and afterload; dilates coronary arteries.

30
Q

How do beta blockers help treat Acute MI?

A

Decrease infarct size, CV complications, decrease mortality.

31
Q

Indications for fibrinolysis in Acute MI (2)?

A

ST elevation in two or more contiguous leads or new LBB.

Time to therapy less than 24 hours.

32
Q

Best diagnostic test for cocaine related chest pain? Treatment? What treatment should be avoided?

A

Troponin I.
Benzodiazepines.
Beta Blockers.

33
Q

Most common location for aortic dissection?

A

Ascending aorta at the ligamentum arteriosum.

34
Q

Stanford Classification for aortic dissections?
Which type is seen in older patients with HTN? Which type is seen in younger patients with Marfan.
Which type is more deadly without surgery?

A

A: involves Ascending aorta w/ or w/o descending (80% of dissections) - HTN.
B: descending aorta only - Marfan.
Type A deadlier without

35
Q

If a patient complains of abrupt and severe tearing or ripping chest pain, you should be most worried about? If this pain is in the back?

A

Ascending Aortic Dissection.

Descending Aortic Dissection.

36
Q

Unequal peripheral pulses found in what % of thoracic aortic dissections?

A

50%

37
Q

After thoracic aortic dissection is seen on CXR, how do you treat it?

A

IV fluids (get SBP to 110, Pulse 60-80).
Nitroprusside + esmolol or Labetalol to decrease contractility and shear stress.
Surgical repair.

38
Q

Most common source of PE?

Rare, but pimpable EKG Finding?

A

Lower extremity DVT.

A large S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III = S1Q3T3.

39
Q

Virchow’s triad?

A

Venous Stasis, hypercoagulability, endothelial cell injury.

40
Q

Number one risk factor for development of PE?

A

Previous DVT/PE.

41
Q

Most common physical findings for PE (3)?

A

Tachypnea, pleuritic chest pain, dyspnea.

42
Q

Most common finding on CXR for PE?
What is Hampton’s Hump?
What is Westermark sign?

A

Atelectasis.
Pleural based wedge shaped infiltrate.
Proximally dilated pulmonary artery with abrupt cut-off.

43
Q

Treatment if high pretest suspiscion of PE?

A

Anticoagulate 1st, order V/Q, CT angio, etc.

Heparin 80 U/kg i.v. bolus; 18 U/kg/hr i.v. drip

44
Q

Treatment if low pretest suspicion of PE?

A

Order V/Q, CT angio, etc., then anticoagulate if necessary.

45
Q

Most common physical findings for Spontaneous pneumothorax?

A

Pleuritic chest pain, decreased breath sounds over affected region, Dyspnea.

46
Q

Cause of spontaneous pneumothorax in thin adult male smoker?

A

Rupture of a sub-pleural bleb.

47
Q

What are the BIG 5 scary causes of Chest Pain.

A

Acute Coronary Syndrome, Pulmonary Embolism, Thoracic Aortic Dissection, Pneumothorax, Esophageal Rupture.

48
Q

5 things to start for each chest pain patient?

A

ABCs; IV, O2, monitor, pOx

Surgery (34 decks)

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