Flashcards in Cardiac Deck (36):
most common causes of "chest pain"
musculoskeletal and GI. Well-localized pain associated with point tenderness is more likely to be musculoskeletal in origin.
pressure, heaviness, tightness, or constriction in the center or left of the chest that is precipitated by exertion and relieved by rest. Other associated symptoms include provocation with emotional stress or cold, radiation (to the neck, jaw, and shoulder), dyspnea, nausea and vomiting, diaphoresis, presyncope, or palpitations.
MI in elderly, women, dm
dyspnea, weakness, nausea and vomiting, palpitations, or syncope
MI or unstable angina, have anginal symptoms at rest, new onset angina that is not stable and predictable (eg, with exertion), or progressive symptoms (angina that is more frequent, longer in duration, or occurs with less exertion than previously). These patients should be referred emergently to an emergency department.
Most common cause of MI
Coronary heart disease
acute chest and back pain that is severe, sharp, and may have a ripping or tearing quality. Pain can radiate anywhere in the chest or into the abdomen
Aortic dissection, A variation in pulse (absence of a proximal extremity or carotid pulse) and/or blood pressure (>20 mmHg difference between the right and left arm)
inflammation of the pericardial sac. Patients often complain of pleuritic chest pain that is improved by sitting up and leaning forward. It can be diagnosed based on history, physical examination, and ECG findings. Etiologies include infection, medications, autoimmune disorders, and malignancy. •Positional pain that improves with sitting up suggests pericarditis.
The most common symptoms of pulmonary embolism include dyspnea followed by pleuritic chest pain, cough, and symptoms of deep venous thrombosis
Patients with spontaneous pneumothorax present with sudden onset of pleuritic chest pain and dyspnea. Hemodynamic instability suggests a tension pneumothorax, which can be life-threatening. A primary spontaneous pneumothorax usually occurs without a precipitating event in young patients (typically in their twenties) with no clinical lung disease. A secondary spontaneous pneumothorax occurs as a complication of underlying lung disease (eg, chronic obstructive pulmonary disease [COPD]). Severity of symptoms depends on the severity of the pneumothorax.
Spontaneous perforation of the esophagus (Boerhaave syndrome) results from a sudden increase in intraesophageal pressure usually caused by straining or vomiting. Patients present with excruciating retrosternal chest pain
Chest pain due to GERD can mimic angina pectoris and may be described as squeezing or burning, located substernally and radiating to the back, neck, jaw, or arms. It can last minutes to hours, and resolves spontaneously or with antacids. It may occur after meals, awaken patients from sleep, and be exacerbated by emotional stress.
Isolated musculoskeletal chest pain syndrome
Patients with isolated musculoskeletal chest pain syndromes have local or regional chest tenderness (table 4) without other symptoms. The most common are costosternal (costochondritis) and lower rib pain syndromes.
Rib fractures are associated with pleuritic chest pain that is localized and reproducible with palpation. Patients often describe an associated injury, though some may occur without trauma.
Chest pain is a common complaint in patients with panic disorder. Panic attacks typically present with spontaneous, discrete episodes of intense fear that begin abruptly and last for several minutes to an hour. In panic disorder, patients experience recurrent panic attacks. Panic disorder may be present in 30 percent or more of patients with chest pain who have no or minimal CHD . Hyperventilation during a panic attack can result in nonanginal chest pain and occasionally ECG changes, particularly nonspecific ST and T wave abnormalities
pleuritic chest pain
Truly pleuritic chest pain is worsened by respiration. Causes of pleuritic chest pain include pericarditis, pulmonary embolism, pneumothorax, pleuritis, and pneumonia
Creatine kinase MB (CK-MB) isoform levels rise to twice normal at six hours and peak within approximately 24 hours.
in the setting of acute myocardial infarction (AMI), advanced assays for cardiac troponin I detect elevations within 3 hours, peak at 12 hours, and remain elevated for 7 to 10 days. Troponins are the preferred test for the diagnosis of AMI. Highly sensitive troponin assays become elevated more rapidly and elevations are even found in patients with what was classically considered to be unstable angina.
Among patients with a low-pretest probability for pulmonary embolus (PE) or aortic dissection, a D-dimer test with high sensitivity can rule out the diagnosis, obviating the need for further testing. The utility of the D-dimer test depends upon both patient baseline characteristics and the sensitivity and specificity of the test employed. Patients likely to have an elevated D-dimer at baseline are the elderly and those with malignancy, sepsis, recent major surgery or trauma, or pregnancy.
B-type natriuretic peptide (BNP) – A number of conditions can elevate the BNP, but levels above 100 pg/mL have a 90 percent sensitivity for acute heart failure (HF) and levels below 50 pg/mL have a 96 percent negative predictive value for HF
Aortic disection testing
Aortic dissection – Several modalities diagnose aortic dissection with high sensitivity, including computed tomography (CT) (98 percent), magnetic resonance imaging (MRI) (98 percent), and transesophageal echocardiography (TEE)
Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiovascular disorder causing systemic perfusion inadequate to meet the body’s metabolic demands without excessively increasing left ventricular filling pressures . It is characterized by specific symptoms, such as dyspnea and fatigue, and signs, such as fluid retention. There are many ways to assess cardiac function. However, there is no diagnostic test for HF, since it is largely a clinical diagnosis that is based upon a careful history and physical examination.
Classes of CHF
●Class I – Patients with heart disease without resulting limitation of physical activity. Ordinary physical activity does not cause HF symptoms such as fatigue or dyspnea.
●Class II – Patients with heart disease resulting in slight limitation of physical activity. Symptoms of HF develop with ordinary activity but there are no symptoms at rest.
●Class III – Patients with heart disease resulting in marked limitation of physical activity. Symptoms of HF develop with less than ordinary physical activity but there are no symptoms at rest.
●Class IV – Patients with heart disease resulting in inability to carry on any physical activity without discomfort. Symptoms of HF may occur even at rest
terminates spontaneously within 7 days
does not terminate in 7 days needs meds or cardioversion
long standing persistent afib
more than 1 year
will not control
no CHF and want to control afib
cardizem (Diltiazem) or verapamil to control HR65
if cannot use a BB for afib can use
amiodarone oral or iv
afib due to CHF medication
prevent stroke w afib
AC based on chadsvasc
need cardioversion if
active ischemia, AKI or organ hypoperfusion, severe HF with pulmonary edema
When to cardiovert
AF 48 delay cardioversion after 3 weeks AC or do a TEE guided cardioversion
CHA2DS2VASC stands for
CHF, HTN, Age > 75, diabetes, Stroke, Vascular disease, age 65-74, sex female
chest discomfort from MI
oxygen demands exceed supply