Chest Pain

Question 1

Cause for Chest Pain

Answer 1

• Aortic Anurism
• Acute Coronary Syndromes: STEMI, NSTEMI, Unsteable Angina
• Costrochondritis : Muscular Issuies
• GERD
• Pericarditis ( Inflamatory)
• PE
• Upper and Lower Airway Infection: PNA or Bronchitis

Question 2

Cardiac labs

Answer 2

**Creatine Kinase (CK): **
* Ensyme Found in Heart, Brain, Skeletal Muscels
* Elevated Levels in Blood indicating Musculesterletol damage
**CK-MP /It is a specific form CK: Cratine Kinase _MP **
Ensymes spesific to Heart

**Troponin: T(T) VS T(I)
* T(T) : Non -Specific to Cardiovascular disease. Associates with Non Cardiovascular Disease
* T(I) : Spercific to Cardiovascular disease Compare to T(T)
* To R/O MI order T(I)
* Float in Blood longer

Question 3

Cardiac Profile

Answer 3

*CMP, CMP, Cardiac Ensymes x 3 Q 6 hrs
EKG, CXR, Stress Test, ECHO, Heath Cath

Question 4

Thoracic Aortic Aneurysm (TAA) : 55 yrs of age leading cause of death USA z

Answer 4

• Chest Pain
• **Upper back pain **
• Symptoms r/t compression of surrounding Structures
• Leads to nerve dysfunction
• **Aterial compression **
• Causes ischemia or thromboembolism

Question 5

TAA Assessment

Answer 5

• B/L UE Blood Pressure difference
• Auculation for Aortic or Vascular Bruits
• Pulse deficits
• Signs of Arterial Ischemia
• Focal Neurologic Deficits
• Signs of central venous compression
• Physical Charactertictics : Marfan Syndrome

Question 6

TAA Imaging

Answer 6

• Widening of Mediastinal Silhoette
• Enlarged Aortic Knob
• Displacement Trachea
• Dispalced Aortic Carlicfication
• Aortic Kinking
• Opacificatio of Aorticopulmonary Window

Question 7

TAA Imaging

Answer 7

• CT angiogram and MRA ( Imaging of choice to defect aneurysm)
  *** Transthoracic Echocardiography (TTI ) : Assessement of Diameters of Aortic Sinuses and Ascending Aorta
  Transesophargeal Echocariography (TEE) **
  Preferred over TTE for Examiniation
  B/C assess entire Aorta

Question 8

TAA Management

Answer 8

• Diameters > than 4.0 ( Need anual assessment )
• Manage CV Rsk : BP wt
• HTN: BBB Goal SBP 105-120
• Elective Repair of Ascending TAA: end diastolic Aortic Dimeter >5.5
• Approach Repair’ OPen Endovascular Hybrib

Question 9

ACS

Answer 9

S**ymptoms **
dulle chest pain
Diaphoresis
Worse on Exertion
RAdiation left
Nausea

Question 10

Pericaditis

Answer 10

Excess Fluid leard to Infussion
It;s Inflammatio Issue with Pericardial Sac
Most common Viral Etiology

Question 10

Costochondrtis

Answer 10

Inflemtation of cardiglage connects ribs to breast bone

Chest pain
Reproductive on Palpation
Sharp Shooting
Cause SOB

Question 10

Pericarditis S/S

Answer 10

Sudden Sharp and Plearitis
Worse on Inspiration /Couphing
Chest Pain: Seating up and Lean Forward
Pericardial Friction Rub
EKG Widespread ST Segment Elevation
Signs of inlammation
ECHO with Effusion

Question 10

Pericarditis Causes

Answer 10

• Viral Most Common
• Idiopathic
• Bactreal
• malignancy
• Autoimmune

Question 11

TX Pericarditis

Answer 11

NSAIDS and Colchicine in combination
Some types Glucocorticoids
Pericardial drainage ( catheter stays until no drainage )
Pericardial Window ( Resistance to medical managment

Question 12

PE

Answer 12

Pleurtitic chest pain
Hymoptysis
cough
chest pain
SOB
Tachycardia
Hypoxia