Flashcards in Aquifer 1 - Chest Pain Deck (103)
List five broad categories of potential causes of chest pain.
Name 5 cardiac etiologies of chest pain
Angina: stable, unstable, or atypical / variant (eg Prinzmetal's)
Valvular heart disease
Name 4 GI etiologies of chest pain
Esophageal disease (GERD, esophagitis, esophageal dysmotility)
Biliary disease (cholecystitis, cholangitis -- typically RUQ with radiation to shoulder, may be referred to chest)
Peptic ulcer disease
Name 6 pulmonary etiologies of chest pain
Pulmonary hypertension/cor pulmonale
Name 5 MSK/neuro etiologies of chest pain
Myofascial pain syndromes
Name 3 psychiatric etiologies of chest pain
What is the management of possible acute coronary syndrome?
What is acute coronary syndrome?
Any group of Sx consistent with acute myocardial ischemia
So, MI (STEMI or NSTEMI) or unstable angina
In what proportion of patients may an initial ECG be non-diagnostic? What is done as a result?
When should cardiac biomarkers be done?
If negative, also at 6h
If negative, also at 12h
Why are troponins particularly good biomarkers?
Very sensitive for MI within last 24h
In which ACS patients would supplemental oxygen be given?
NSTE-ACS and one of:
- arterial oxygen saturation less than 90%
- respiratory distress
- other high-risk features of hypoxemia.
What are the STEEEP goals for medicine?
Safe, Timely, Effective, Efficient, Equitable, and Patient-Centered
What history should be elicited from patients with suspected ACS?
Assoc Sx: nausea, diaphoresis, SOB
Cardiac risk factors
Distinguish ischemic from non-ischemic pain
Remember ACS can present with atypical Sx
Name 5 cardiac risk factors (7 listed)
PMHx or FHx of CAD
peripheral arterial disease
Name 5 symptoms commonly associated with ACS
Belching, nausea, indigestion
What proportion of patients who come to the ED with an MI have the "classic" severe substernal chest pressure.?
Name 5 terms pt often use to describe cardiac chest pain (many listed)
knot in chest
lump in throat
heavy weight on chest
like a bra too tight
What are the features of cardiac chest pain?
Diffuse discomfort, difficult to localize; not one specific spot
Radiation: shoulders, arms, neck & throat, lower jaw & teeth (not upper jaw), epigastrium, sometimes back
Exertional; relieved by rest or nitro
What components of the physical exam are important for acute chest pain?
Vital signs for tachycardia, hypotension, or hypertension.
Cardiac exam for murmur, S3 or S4 gallop, auscultation and palpation of pulses.
Chest pain and pericardial rub suggest ....
Chest pain and lung crackles suggest ...
Chest pain and fever, crackles, and decreased breath sounds suggest ...
Chest pain and unilateral leg swelling and/or tenderness suggest ...
Chest pain and RUQ tenderness suggest ...
Chest pain and epigastric discomfort on palpation suggest ...
Chest pain and chest wall tenderness suggest ...
trauma, costochondritis, and other muscular causes of chest pain
Could also be ACS
Chest pain and Pulse and BP differential from side to side suggest ...
significant peripheral arterial obstruction - including aortic dissection!
Chest pain and diastolic heart murmur suggest ...