Adams "Chest Pain" Flashcards
(56 cards)
Heart shows something is wrong by:
chest pain
Differential of Chest pain
anxiety ASS asthma cardiomyopathy esophagitis gastroenteritis hypertensive emergency myocarditis pericarditis cardiac tamponade aortic dissection PE shingles
Brain says something is wrong by:
HA and vomiting
“Never let clothing stand between you and the diagnosis”
Shingles
“Doc, I think an elephant is on my chest and I am going to die!”
Classic MI presentation
ACS
Acute Coronary Syndrome
-non-cardiac disease
-stable angina
-unstable angina (60%
-definite ischemic event
STEMI 30%, NSTEMI 25%)
Unstable angina worries
hard to diagnose because no elevated troponin AND will go on to have an MI in next 10 days
MI Classic presentation
Hx: early AM presentation with substernal achy pressure
pain radiates to anterior neck, shoulders, left arm, and back
- “chest pain”
- dyspnea (SOB)
- nausea
- diaphoresis (sweating)
What percentage of MI presentations will have “chest pain?”
about 50%
- the other 50% will have SOB, nausea, sweating or other weird symptom
Classic MI Qs to ask
RISK FACTORS
Risk Factors for MI
- past hx of CAD
- smoker
- HTN
- elevated cholesterol
- family hx of CAD (mom died before
Typical physical exam findings of MI
*doesn’t lend much info most of the time
- chest clear
- RRR without murmur, S3, S4 or rub
- abdomen soft, guaiac negative stool
- no peripheral edema
- diaphoretic skin
Alternative presenations of MI
- no “pain”
- SOB
- sweaty
- syncope
- stroke
- palpitation
- indigestion
- weakness
- pain in referred areas, such as right arm/hand or abdomen
*use adjectives to help them describe their chest: heart burn? pressure? squeezing? burning? numbness?
Alternative presenations in populations…
- syncope and weakness in elderly
- women, young, and elderly present atypical
Alternative physical
S3: LV dysfunction
S4: decreased LV compliance
new murmur: papillary muscle tear/dysfunction
CHF: crackles, hepatojugular reflux, leg edema
___ and ___ (of ACS) can look same initially on EKG
UA and NSTEMI look same initially on EKGs
vs.
STEMI
NSTEMI and q waves…
No Q wave MI
Q wave MI
STEMI and q waves…
No Q wave MI
Q wave MI**most
Angina
- symptom rather than a diagnosis
- mismatch of oxygen demand and delivered oxygen to cardiac muscle –> ischemia (reversible)
How long does angina last
30 minutes = ischemia (no longer angina)
Types of angina
- stable angina (can be very freq and still stable, less predictive of CAD in women)
- prinzmetal’s (vasospasm, assoc with ST elevations, occurs at rest, often night, rarely with exercise)
- unstable angina (increasing duration, freq, intensity, new associated symptoms, occur with increasly less activity and rest)
*10% of unstable angina will have MI in 7 days
grade I angina
“ordinary physical activity doesn’t cause angina” (walking, stairs, etc.)
angina occurs with strenuous, rapid or prolonged exertion at work or recreation
grade II angina
“slight limitation of ordinary activity”
occurs on walking or climbing stairs rapidly, walking uphill, walk/stair after meals, cold/wind, under emotional stress, few hours after awakening
*walking more than 2 blocks on level ground and climibng more than 1 flight of ordinary stairs at normal pace and normal conditions
grade III angina
“marked limitations of ordinary physical activity”
angina occurs on walking
1-2 blocks on the level and climbing 1 flight stairs under normal conditions and normal pace
