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Flashcards in Chest Pain Deck (21)
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1
Q
Common causes of nonemergent chest pain
(in order from highest prevalence to least)
A
1. Musculoskeletal (costochondritis)
2. GI, other/unknown
3. Cardiac (stable angina, other, then unstable/MI)
4. psychiatric
5. pulmonary
2
Q
S/S of GERD (non cardiac cause of chest pain)
A
visceral, substernal, worse w/ recumbency, no radiation, relief w/ food and antacids
-pain lasts 5 mins- 1 hr
3
Q
S/S of Esophageal spasm (non cardiac cause of chest pain)
A
-visceral, spontaneous, substernal, associated w/ cold liquids, relief w/ nitroglycerine
-pain lasts 5 mins- 1 hr
4
Q
S/S of Peptic ulcer (non cardiac cause of chest pain)
A
-visceral, burning, epigastric, relief w/ food and antacids, normal EKG
-pain lasts hrs
5
Q
S/S of Biliary disease (non cardiac cause of chest pain)
A
-visceral, epigastric, interscapular colic, occurs after meals
-pain lasts hours
6
Q
S/S of Cervical disc (non cardiac cause of chest pain)
A
-superficial, positional, arm and neck
7
Q
S/S of Musculoskeletal (non cardiac cause of chest pain)
A
-superficial, positional, worse w/ movement, local tenderness
8
Q
S/S of Hyperventilation (non cardiac cause of chest pain)
A
-visceral, substernal, tachypneic, anxious
-pain lasts 2-3 mins
9
Q
S/S of Thyroiditis (non cardiac cause of chest pain)
A
-aggravated by swallowing, neck, throat tenderness
-persistent
10
Q
TRUE chest pain (angina)
A
-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
11
Q
Definite angina
A
substernal discomfort precipitated by exertion, w a typical radiation to the shoulder, jaw or inner aspect of arm, relieved by rest or nitro in less than 10 mins
12
Q
Probable angina
A
Has most of the features of definite angina but my not be entirely typical in some aspects
13
Q
"Probably not" angina
A
atypical overall pattern of chest pain that does not fin in the description of definite angina
14
Q
"Definitely not" angina
A
chest pain is unrelated to activity, appears to be clearly of non-cardiac origin and is not relieved by nitro
15
Q
Associated symptoms with chest pain
A
Shortness of breath
Nausea
Diaphoresis
Palpitations
“Impending sense of doom”
16
Q
"Silent" MIs are most commonly seen in
A
elderly, women, diabetics
17
Q
TIMI risk score
A
-categorizes a patient's risk of death and ischemic events and provides a basis for therapeutic decision making
18
Q
Calculating TIMI risk score
A
1 point for each:
-Age ≥ 65
-Aspirin use in the last 7 days (patient experiences chest pain despite ASA use in past 7 days)
-At least 2 angina episodes within the last 24hrs
-ST changes of at least 0.5mm in contiguous leads
-Elevated serum cardiac biomarkers
-Known Coronary Artery Disease (CAD) (coronary stenosis ≥ 50%)
-At least 3 risk factors for CAD:
1. Hypertension -> 140/90 or on anti-hypertensives
2. Current cigarette smoker
3. Low HDL cholesterol (
19
Q
TIMI scoring
A
Score of 0-1 = 4.7% risk
Score of 2 = 8.3% risk
Score of 3 = 13.2% risk
Score of 4 = 19.9% risk
Score of 5 = 26.2% risk
Score of 6-7 = at least 40.9% risk
20
Q
Initial work up for chest pain
A
EKG
Cardiac enzymes
CXR
21
Q
OMM
A
rib raising