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Cardiovascular > CM Chest Pain History > Flashcards

CM Chest Pain History Flashcards

1
Q

What does a diagnostic approach to chest discomfort consider?

A

Uses a complex understanding of common and life-threatening diagnoses to sort through possibilities effectively.

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2
Q

Common life threatening diagnoses from chest pain?

A

Myocardial Infarction, Pulmonary Embolism, Aortic Dissection.

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3
Q

What is a differential diagnosis?

A

A list of diagnostic possibilities that arise after taking a history.

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4
Q

What should a differential diagnosis include?

A

Leading diagnostic possibilities, plausible alternatives, life-threatening possibilities.

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5
Q

What are the cardinal chief complaints for heart disease?

A 
Chest discomfort
Shortness of Breath
Lower Extremity Edema
Palpitations
Syncope
Cough
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6
Q

Why is the patient centered aspect of a history important?

A

Pure gold, unbiased info
Leads you might miss
Establish rapport
Being present

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7
Q

What are the differences in using OLDCARTS and Pivotal Quesstions?

A

OLDCARTS helps you gather information to begin to make a diagnosis

Pivotal questions help you rule in or rule out other possible diagnoses

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8
Q

What is a syndrome?

A

A syndrome is a set of symptoms, that may be common to several diseases

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9
Q

What structures may be responsible for chest discomfort?

A

Heart, Aorta, Lung, Pericardium/Pleura, Stomach, Brain, Skin

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10
Q

What are the causes of Coronary Atherosclerosis?

A

Cause: Narrowing of coronary artery leading to mismatch of oxygen supply and oxygen demand

Myocardial Ischemia leads to pain

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11
Q

Compare and contrast Stable and Unstable plaques?

A

Atherosclerosis is divided into two groups: Stable and Unstable plaques

Stable plaques result in fixed obstruction of a vessel and cause stable angina, which is constant at rest and worsens only with exertion

Unstable plaques result in obstruction of multiple vessels, and cause unstable angina/acute coronary syndrome

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12
Q

Compare and contrast how Angina can present?

A

Angina may be stable or unstable

Stable plaque = Stable angina = localized + painless at rest + worsens with exertion

Unstable plaque = unstable angina = diffuse pain + painful at rest + worsens with exertion

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13
Q

How do pain and exertion support or oppose Angina?

A

Treating Angina as pain that is truly associated with the heart, and not another compartment:

Increased discomfort due to exertion + relief with rest = Angina due to increased Oxygen demand worsening pain

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14
Q

How does the type of pain support or oppose Angina?

A

Dull chest pain = Angina since visceral organs like the heart are innervated by the PNS and give off dull pain signals

Sharp chest pain = Not Angina because somatic organs other than the heart are innervated by the SNS and give off sharp pain signals

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15
Q

How does radiation to other areas support or oppose Angina?

A

Collateral arm and/or jaw pain on either side suggests Angina due to shared innervation and referred pain

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16
Q

What are they key clinical features of Angina?

A 
Brought on by exertion
Relieved by rest or Nitroglycerin
Describes as dull, pressure
May be described as indigestion
Never lasts seconds, rarely lasts days
Can radiate to jaw/arms/neck
Can be associated with nausea/vomiting
17
Q

What is Aortic Dissection?

A

A tear in the Media of the Aorta leading to the formation of a dissection flap

Can compromise blood flow or rupture Aorta entirely

18
Q

What are the key clinical features of Aortic Dissection?

A 
Sudden onset
Tearing or ripping pain
Very severe
History of hypertension
Radiates to the back
19
Q

What is a Pulmonary Embolism?

A

Blood clot travels to pulmonary vasculature and lodges, compromising blood flow

20
Q

How does Shortness of Breath support or oppose Pulmonary Embolism?

A

Shortness of Breath increases the likelihood of pulmonary embolism, since a blood clot in an artery in the lung will cut off blood flow to that area, lowering the amount of oxygenated blood in circulation and causing shortness o f breath

No Shortness of Breath = Pulmonary Embolism less likley

21
Q

How does pain support or oppose Pulmonary Embolism?

A

Sharp pain = Pulmonary embolism since a clot that lodges in an artery causes inflammation that damages Pleural tissue, which is innervated by the SNS and detected as sharp pain; additionally, clot stretches the artery causing SNS sharp pain

Dull pain generally opposes Pulmonary Embolism but could occur if blood flow to the Left Ventricle is cut off

22
Q

How does pain and breathing support or oppose Pulmonary Embolism?

A

Pulmonary Embolism worsens with inspiration because it is a form of pleuritic pain

23
Q

What are the key features of Pulmonary Embolism?

A

Pleuritic pain (sharp, worse on inspiration)
Shortness of breath
Hemoptysis
DVT due to recent travel

24
Q

What is Tension Pneumothorax?

A

A rare but life threatening cannot miss diagnosis, occurs when air is trapped inside the Pleural cavity and displaces the mediastinal structures

25
Q

What are they clinical features of Tension Pneumothorax?

A

May be related to previous trauma
Not found in history
Absence of breath sounds on one side, the displaced side Severe shortness of breath

26
Q

What is Pericarditis?

A

Inflammation of the pericardium, secondary to other etiologies such as viral infection

27
Q

How does pain support or oppose Pericarditis?

A

Sharp pain = support Pericarditis because the Pericardial sac is innervated by the SNS which transmits sharp pain signals

28
Q

How is Pericarditis differentiated from other Pleural Pain?

A

Pericarditis is very localized to the heart, whereas other pleural pains are more diffuse or in other organs

29
Q

What are the key clinical features of Pericarditis?

A 
Sharp pain, that may vary with respiration
Varies with position
Can radiate to the back
Can be associated with fever
ECG changes often present
30
Q

What is Esophageal Rupture?

A

Aka Boerhaave’s Syndrome, rupture of the esophagus

31
Q

What are the key clinical features of Boerhaave’s Syndrome?

A

Found in setting of severe vomiting and severe chest/upper abdominal pain

Free air in mediastinum on X-ray

32
Q

What is GERD?

A

Gastroesophageal Reflux Disease is stomach acid refluxing into the esophagus causing pain

33
Q

What are the key clinical features of GERD?

A

Burning pain described as indigestion
Associated with meals
Can occur at night, while lying down

34
Q

What is Peptic Ulcer Disease?

A

Peptic ulcers = ulcers in lining of stomach or duodenum
Caused by H. pylori
Heartburn or indigestion symptoms
Can be better or worse with meals

Cardiovascular (25 decks)

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