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Flashcards in Chest Pain Deck (21)
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1

Common causes of nonemergent chest pain
(in order from highest prevalence to least)

1. Musculoskeletal (costochondritis)
2. GI, other/unknown
3. Cardiac (stable angina, other, then unstable/MI)
4. psychiatric
5. pulmonary

2

S/S of GERD (non cardiac cause of chest pain)

visceral, substernal, worse w/ recumbency, no radiation, relief w/ food and antacids
-pain lasts 5 mins- 1 hr

3

S/S of Esophageal spasm (non cardiac cause of chest pain)

-visceral, spontaneous, substernal, associated w/ cold liquids, relief w/ nitroglycerine
-pain lasts 5 mins- 1 hr

4

S/S of Peptic ulcer (non cardiac cause of chest pain)

-visceral, burning, epigastric, relief w/ food and antacids, normal EKG
-pain lasts hrs

5

S/S of Biliary disease (non cardiac cause of chest pain)

-visceral, epigastric, interscapular colic, occurs after meals
-pain lasts hours

6

S/S of Cervical disc (non cardiac cause of chest pain)

-superficial, positional, arm and neck

7

S/S of Musculoskeletal (non cardiac cause of chest pain)

-superficial, positional, worse w/ movement, local tenderness

8

S/S of Hyperventilation (non cardiac cause of chest pain)

-visceral, substernal, tachypneic, anxious
-pain lasts 2-3 mins

9

S/S of Thyroiditis (non cardiac cause of chest pain)

-aggravated by swallowing, neck, throat tenderness
-persistent

10

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

11

Definite angina

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

Probable angina

Has most of the features of definite angina but my not be entirely typical in some aspects

13

"Probably not" angina

atypical overall pattern of chest pain that does not fin in the description of definite angina

14

"Definitely not" angina

chest pain is unrelated to activity, appears to be clearly of non-cardiac origin and is not relieved by nitro

15

Associated symptoms with chest pain

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

16

"Silent" MIs are most commonly seen in

elderly, women, diabetics

17

TIMI risk score

-categorizes a patient's risk of death and ischemic events and provides a basis for therapeutic decision making

18

Calculating TIMI risk score

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

TIMI scoring

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

Initial work up for chest pain

EKG
Cardiac enzymes
CXR

21

OMM

rib raising