chest pain Flashcards Preview

Family Medicine > chest pain > Flashcards

Flashcards in chest pain Deck (18):
1

pressure/squeezing/crushing/smothering sensation in substernal chest AT REST or with minimal exertion or episodes of increasing frequency, severity, or duration
+/- radiation to jaw, shoulder, arm, hand (usually left side)
SOB, sweating
HTN, tachycardic
S4 gallop

unstable angina pectoris

2

treatment of unstable angina

MONA:
Morphine: ↓ circulating catecholamines →↓ myocardial O2 consumption
Oxygen: 2-4 L/min NC
Nitroglycerin: ↓ myocardial damage + bp, ↓ risk future MI, sublingual, in absence of hypotension or sildenafil: q 5 min x 3 doses → IV or transdermal
B blocker: ↓ myocardial damage + bp, ↓ risk future MI, ↓ mortality, ↓infarct size
Aspirin: ↓ risk future MI + death, 325 mg chewed and swallowed (clopidogrel if allergy)
heparin:↓ risk future MI + death, continue for 2 days or until angiography performed
ACEi: ↓ short-term mortality if started within 24 hrs of acute MI, prevent LV remodeling, ↓ recurrent ischemia, continue indefinately
Mg sulfate: if low Mg to prevent TdP
HMG-CoA reductase inhibitor (statins): within few days of onset
if + EKG changes, add:
GP IIb/IIIa inhibitors (if high-risk unstable angina or non-STEMI treated with percutaneous coronary intervention or refractory to prior treatment): ↓ recurrent ischemia, MI, death

3

evaluation of unstable angina

ED: EKG + CXR first, CBC, electrolytes, BUN, Cr, PT, PTT, INR, glucose, creatine kinase + MB isoenzyme, troponin T (markers repeat q 6-10 hrs x3)
later studies: fasting lipids, LFT, Mg, homocysteine, UDS, UA, myoglobin

4

EKG changes

ST elevation
ST depression
T wave inversion
Q wave: myocardial necrosis from completed infarction (benefit of thrombolytic tx uncertain)
LBBB: associated with CAD - draw cardiac enzymes, mimics acute and chronic ischemic changes

5

elevated CK-MB and/or troponin levels +/- EKG changes

MI

6

normal EKG

doesn't rule out MI

7

cardiac muscle death d/t partial or complete occlusion of one or more coronary arteries

MI

8

angina only with unusually strenuous activity

class I

9

angina with more prolonged and vigourous acitivity

class II

10

angina with daily activity

class III

11

angina at rest

class IV

12

cause of acute MI

atherosclerotic plaque rupture → coronary artery thrombosis

13

causes of angina

coronary artery spasm: cocaine-induced
aortic dissection: extending into coronary artery
endocarditis, prosthetic heart valve, myxoma: emobuls into a coronary artery

14

risk factors for chest pain conditions

DM
hyperlipidemia: MI
HTN: CAD, aortic dissection
tobacco use: CAD, thromboembolism, aortic dissection, pneumothorax, pneumonia
family hx premature CAD: MI
male gender >40 yo: CAD
postmenopausal status
LV hypertrophy: MI
trauma to chest: pneumothorax, myocardial or pulm contusion, chest wall injury
homocystinemia

15

treatment of CAD

primary and preventative treatment:
aspirin: ↓ risk CAD + CVA
nitrates: treat angina symptoms
B blocker: ↓ first-year mortality
statin

16

chest pain lasts

stable/unstable angina

17

chest pain lasts > 30 minutes
+ serum cardiac enzymes
+/- EKG changes
nausea/vomiting: if large

MI

18

global ST elevation in most leads
sharp pain worse with inspiration, better with leaning forward

pericarditis