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Flashcards in chest pain Deck (23):
1

ddx chest pain

cocaine: inc. SNS-->inc. HR, coronary vasospasms (Prinz metal angina)
MI
PE
pheochromocytoma
amphetamine intoxication
GERD
asthma
COPD
musculoskeletal
pericarditis
rheumatic disease
neuropathy
CAD
coronary vasospasm
valvular heart disease
CHF
myocarditis
acute aortic syndrome
stress-induced cardiomyopathy (Takatsubus?)
esophageal rupture, perf, hypersn
esophagitis
pulmonary hypertension
pneumonia
lung cancer
sarcoidosis
pneumothorax
pleuritis
pleural effusion
HSV (shingles)
mallory-Weiss tear: GE junction tear from GERD, etOH, vomiting
Boerhaave: if complete tear
hyperthyroidism- thyroid storm
SCD-->vaso-occlusive ulcer
anxiety: panic attacks
cardia temponade
pericardial effusion
costochondritis (chronic cough)
a fib w. RVR
foreign body
mastitis
GSW
appendicitis
cholestasis of pregnancy-->cholecystitis
endocarditis
PUD

2

“True” chest pain (angina)

Usually last 5-20 minutes
Located retrosternal, left precordial
Commonly referred to lower jaw, left arm
Pressure, tightness, squeezing, “elephant sitting on my chest”
-Not sharp

3

angina scale

slide- 18

4

alt. ddx to ischemia

slide 12

life-threatening:
aortic dissection
PE
tension pneumothorax
esophageal rupture
perforating PUD

5

non-ischemic

aortic dissection
myocarditis
pericarditis

6

chest wall

cervical disc disease
costochondritis
fibrositis
HSV (post herpatic neuralgia)
neuropathic pain
rib fx
sternoclavicular arthritis

7

pulmonary

??

8

psych

??

9

GI

??

10

percentage of CP

musculoskeletal: 36%
GI: 19%
cardiac: 16%
-stable: 10.5%
-unstable/MI: 1.5%
-other cardiac: 3.8%
psych: 8%
pulmonary: 5%
other: 16%

11

GERD characteristics

??

12

esophageal spasm

??

13

PUD char.

??

14

biliary disease

??

15

cervical disc characteristics

??

16

musculoskeletal characteristics

??

17

hyperventilation

??

18

thyroiditis characteristics

??

19

associated symptoms (red flags)

Shortness of breath
Nausea
Diaphoresis
Palpitations
“Impending sense of doom”

20

"silent" MI

Elderly
Women (equivalent to men @ 60 yo)
Diabetes

atypical
ear pain?

21

TIMI risk score

to come later
-affects triage, tx
risk stratification

22

Initial workup

EKG
Cardiac enzymes (can sometimes fool you)
CXR

23

unstable angina tx:

MONA
morphine
oxygen
nitro
ASA