Chest Pain

Question 1

immediate life-threatening causes of chest pain include

Answer 1

acute MI/acute CAS
pulmonary embolism
aortic dissection
tension pneumothorax
pericardial tamponade
esophageal rupture

Question 2

tearing pain

pain radiating between scapula from chest wall

Answer 2

aortic dissection

Question 3

no symptoms or acute SOB, hyperesonnant areas over pneumothorax

Answer 3

tension pneumothorax

Question 4

what sort of pt will have spontaneous pnemothorax?

Answer 4

vomitting or vomitting blood

Question 5

what can mimick an MI

Answer 5

esophageal spasm

Question 6

leading cause of death in US

Answer 6

Acute coronary syndrome/MI

Question 7

angina pectoris

Answer 7

discomfort induced by exercise and relived by rest and or nitroglycerin
- due to ischemia of heart muscles

Question 8

unstable angina

Answer 8

occurs with more frequent occurence of anginal episodes, longer lived episodes or more easily provoked angina.

Question 9

Atypical or Prinzmetal angina

Answer 9

angina that occurs at rest

Question 10

what is the main cause of angina pectoris?

Answer 10

ischemia of heart muscle and

atherosclerosis of coronary arteries feeding heart

Question 11

what is the cardinal sign of decreased blood flow to the heart?

Answer 11

chest pain experienced as tightness around the chest and radiationg to the left arm and left angle of jaw
- diaphoresis, nausea, vomitting, SOB, anxiety, impending doom

Question 12

ischemic heart disease includes

Answer 12

MI
angina pectoris
heart failure

Question 13

high risk characteristics for ACS

Answer 13

pressure or squeezing
pain similar to prior AMI or angina
radiation to neck/shoulders, or left arm
associated dyspnea

Question 14

MI in what areas of the heart could cause pulse to drop?

Answer 14

posterior aspect of L ventricle
anywhere in R ventricle
anywhere near apex
* all these areas can cause stimulation of vagus nerve which causes pulse to drop

Question 15

unequal pulses
pain radiating to back
new murmur or aortic insufficiency

Answer 15

aortic dissection

Question 16

Beck’s triad

Answer 16

cardiac tamponade

Question 17

decreased breath sounds

Answer 17

pneumothorax

Question 18

ST elevation MI 30%

Answer 18

STEMI

Question 19

non-ST elevation MI 25%

Answer 19

Non-STEMI

Question 20

unstable angina causes what % of MI

Answer 20

38%

Question 21

plaque rupt\ptre and obstructrion occur when?

Answer 21

when lipid core is exposed to blood as it causes platelet aggregation

Question 22

what is most sensitive test to rule out MI?

Answer 22

troponin

Question 23

what does aspirin do?

Answer 23

platelet aggregation inhibitor

Question 24

how is acute MI treated

Answer 24

oxygen
aspirin
sublingual nitroglycerin

Question 25

how do you treat an MI with ST elevation

Answer 25

reperfusion therapy | percutaneous coronary intervention (PCI) or thrombolytic drugs (clot busters)

Question 26

How do you treat a non-STEMI

Answer 26

medication or angioplasty might be needed | - bypass surgery for multiple blockages or DM pt

Question 27

percutaneous coronary intervention (PCI)

Answer 27

non surgical procedure used to treat stenotic coronary arteries. Balloon inflated through femoral artery to blockage.

Question 28

Troponin complex

Answer 28

Troponin C Troponin I Trponin T

Question 29

medication for STEMI

Answer 29

clopidogrel 600mg stat SC Enoxipren 1mg/kg PCI or thrombolysis if

Question 30

aortic aneurism

Answer 30

any swelling of aorta greater than 1.5 times normal - represents underlying weakness in the wall of aorta at that location. - risk of rupture can lead to death

Question 31

common sign of aortic aneurism at arch

Answer 31

hoarse voice

Question 32

cardiac tamponad

Answer 32

caused by the buildup of fluid inside pericardium

Question 33

Beck's Triad

Answer 33

``` Sign of cardiac tamponade - Dropping BP - Acute JVD - Muffled heart sounds and narrow pulse pressure - lean them into stethescope to hear ```

Question 34

pulsus paradoxus

Answer 34

another sign of cardiac tamponade | - a drop in at least 10mmHg in arterial BP on inspiration and general signs of shock

Question 35

diagnostic test of choice for cardiac tamponade?

Answer 35

echocardiogram - will show enlarged pericardium or collapsed ventricles - chest xray will show large globular heart