Chest pain Flashcards Preview

Crrab 1 > Chest pain > Flashcards

Flashcards in Chest pain Deck (29):
1

What are some ddx for chest pain?

Anxiety
Aortic stenosis
Pericarditis
Pleuritis
Myocarditis
Cardiomyopathy
Aortic dissection
Asthma
Esophagitis
Gastroenteritis
MI
PE
Cardiac tamponade
HTN emergency
Skin- lac or shingles

2

What is the flow chart for Acute coronary syndrome?

1. Non cardiac
2. Stable angina
3. Unstable angina
4. Definite ischemic event

3

What is the classic presentation of MI?

Pt presents early AM with substernal achy pressure
- Radiated pain to ant neck, shoulder, left arm, back and jaw
- 50% only have chest pain
- SOB
- Nausea
- Sweating

4

What are some classic risk factors for MI?

Past hx of CAD
- Smoking
- HTN
- Hypercholesterolemia
- DMD
- Family hx of CAD
- Elevated CRP

5

At what ages is family hx relevant?

Father

6

Do women and young present with typical or atypical sx's?

No they do not
-No pain
- SOB
-sweaty
- Syncope
- Palpitation
- indigestion
- weakness

7

What does a new murmur suggest with a pt with chest pain?

MI which caused a papillary muscle rupture

8

What looks the same about in EKG as NSTEMI?

Unstable angina

9

Do most STEMI's have q waves or no?

Most do
- Not definitive to rule it a STEMI if Q waves present though
- STEMI's can also show up without Q waves

10

What are some characteristics of stable angina?

Can be very frequent
Not always predictive of CAD in women (only 50-60%)
- Men 80-99% predictive

11

What is Prinzmentals angina?

Vasospasm
- Ass with ST elevations
- Occurs at rest and often at night
- Rarely during exercise

12

What is unstable angina?

Increases in duration, freq and intensity
- New ass sx's
- Occurring with increasingly less activity at rest

13

What is Grade I angina?

Ordinary physical activity does not cause angina such as walking or climbing stairs but very strenuous rapid or prolong exertion can evoke it

14

What is grade IV angina?

Inability to carry our any physical activity
- angina at rest

15

Criteria for defining an MI?

Elevated trop and at least 1 of the following:
1. Sx of ischemia
2. Q wave dev
3. New ST/T wave changes or new LBBB
4. Intracornary thrombus
5. Loss of cardiac wall (echo)

16

Can EKG's be normal with an MI?

yes nearly 1/3 early on
- get serial and compare. If not acute changes no reason for further evaluation
- If inferior get right side leads

17

What is unique about a Posterior MI?

ST depression rather than elevation

18

What is the dx criteria for STEMI?

STE >1mm in 2 contiguous leads
- if V2/3 need additional 2 contiguous lead with >2mm in men and >1.5 mm in women

19

What is indicative of LBB on EKG with relation to T wave and QRS?

Discordant
- One goes up and the other goes down or vice versa

20

What is indicative or diagnostic for MI regarding QRS and T wave?

Concordant
- Ones goes up and so does the other in just 1 lead
- > or equal too >1mm of Concordant STE
≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression

21

What can cause a false + trop/

A-fib
Sepsis
Chronic kidney dz
- Can still be normal with unstable angina

22

What heart scores and risk of MACE and their correlation to management?

0-3= 1-6% MACE: discharge them
4-6= 13% MACE: Admit for observation and serial trops and EKGs
7-10= 50% MACE: invasive intervention

23

What is the management of possible ACS?

-Low risk: ASA, conservative observation with repeat troponin in 6-12 hours
-Moderate to high: nitroglycerin, heparin, repeat troponin in 6-12 hours
-Possibly repeat EKG before the repeat troponin.

24

What is the management of a UA or NSTEMI?

PCI
Meds

25

What is the management of STEMI?

Fibrinolytics
PCI with dilation and stinting
CABG
Meds like Heparin, aspirin and Ticegralor

26

What are the antiplatelet management meds for MI besides aspirin?

-Clopidogel should be given if unable to take aspirin. Use in all patient less than 75 of age with UA/NSTEMI or STEMI
-Inhibits adenosine 5'-diphosphate (ADP)–dependent activation of the glycoprotein IIb/IIIa complex, a necessary step for platelet aggregation.
-Others: prasugrel, ticagrelor

27

What are some anticoagulant therapies for MI?

-UFH (unfractionated heparin)
-Enoxaparin (low molecular weight heparin)
-Fondaparinux
similar to Enoxaparin
-Bivalirudin
direct thrombin inhibitors

28

What are the glycoprotein IIb/IIIa inhibitors for?

-Use is primarily in conjunction with PCI
-Inhibit the integrin GP IIb/IIIa receptor in platelet membrane
-Inhibits final common pathway to activation of platelet aggregation

29

Management in first 24 hrs for MI?

-Angiotensin converting enzyme inhibitors
in patients with CHF or LV ejection ≤ to 40% with no hypotension. If contraindicated use a angiotensin receptor blocker
-ß Blockers
an 11% reduction in mortality (use within 24 hours and not in high risk patients, low output , CHF, heart blocks, asthma) If contraindicated, use Calcium channel blockers (if no LV dysfunction)