Aquifer 1 - Chest Pain Flashcards Preview

IM Internal Med > Aquifer 1 - Chest Pain > Flashcards

Flashcards in Aquifer 1 - Chest Pain Deck (103)
Loading flashcards...
1

List five broad categories of potential causes of chest pain.

Cardiac
GI
Pulmonary
Musculoskeletal
Psychogenic

2

Name 5 cardiac etiologies of chest pain

Angina: stable, unstable, or atypical / variant (eg Prinzmetal's)
Acute MI
Cocaine-induced

Pericarditis

Aortic dissection

Valvular heart disease

Arrythmia

3

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

Pancreatitis

4

Name 6 pulmonary etiologies of chest pain

Pneumonia
Spontaneous pneumothorax
Pleuritis
Pulmonary embolism
Pulmonary hypertension/cor pulmonale
Pleural effusion

5

Name 5 MSK/neuro etiologies of chest pain

Costochondritis
Rib fracture
Myofascial pain syndromes
Muscular strain
Herpes zoster

6

Name 3 psychiatric etiologies of chest pain

Panic disorders
Hyperventilation
Somatoform disorders

7

What is the management of possible acute coronary syndrome?

Aspirin
ECG
Troponins

8

What is acute coronary syndrome?

Any group of Sx consistent with acute myocardial ischemia

So, MI (STEMI or NSTEMI) or unstable angina

9

In what proportion of patients may an initial ECG be non-diagnostic? What is done as a result?

Half

Serial ECGs

10

When should cardiac biomarkers be done?

Initial workup
If negative, also at 6h
If negative, also at 12h

11

Why are troponins particularly good biomarkers?

Very sensitive for MI within last 24h

12

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.

13

What are the STEEEP goals for medicine?

Safe, Timely, Effective, Efficient, Equitable, and Patient-Centered

14

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

15

Name 5 cardiac risk factors (7 listed)

Smoking
HTN
Dyslipidemia
DM
PMHx or FHx of CAD
peripheral arterial disease
stroke

16

Name 5 symptoms commonly associated with ACS

SOB
diaphoresis
Belching, nausea, indigestion
dizziness, syncope
weakness, fatigue

17

What proportion of patients who come to the ED with an MI have the "classic" severe substernal chest pressure.?

25%

18

Name 5 terms pt often use to describe cardiac chest pain (many listed)

Squeezing
tightness
pressure
crushing
constriction
strangling
burning
heart burn
fullness
band-like sensation
knot in chest
lump in throat
heavy weight on chest
like a bra too tight

19

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

20

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.

21

Chest pain and pericardial rub suggest ....

Pericarditis

22

Chest pain and lung crackles suggest ...

heart failure

23

Chest pain and fever, crackles, and decreased breath sounds suggest ...

pneumonia

24

Chest pain and unilateral leg swelling and/or tenderness suggest ...

DVT/PE

25

Chest pain and RUQ tenderness suggest ...

acute cholecystitis

26

Chest pain and epigastric discomfort on palpation suggest ...

GERD

27

Chest pain and chest wall tenderness suggest ...

trauma, costochondritis, and other muscular causes of chest pain

Could also be ACS

28

Chest pain and Pulse and BP differential from side to side suggest ...

significant peripheral arterial obstruction - including aortic dissection!

29

Chest pain and diastolic heart murmur suggest ...

Aortic dissection

30

Refresh: Guidelines for good summary statements

1) Include accurate information and not include misleading information.

2) Facilitate understanding of the primary problem and appropriately narrow the differential diagnosis through the inclusion of pertinent key features. (The aim is to frame understanding of the primary problem rather than to report all information indiscriminately.)

3) Express key findings in qualified medical terminology (e.g., heart rate of 180 beats/minute is tachycardia); synthesize details into unifying medical concepts (e.g., retractions + hypoxia + wheezing = respiratory distress).

4) Use qualitative terms that are more abstract than patient's signs; these are often binary in nature (e.g., acute vs. chronic; constant vs. intermittent).