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Chest Pain Flashcards

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1
Q

Myocardial Ischemia causing chest discomfort. Harrison’s 19th edition page 95

A

Angina Pectoris

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2
Q

Precipitated by imbalance between myocardial oxygen requirements and myocardial oxygen supply, resulting in insufficient delivery of oxygen to meet the heart’s metabolic demands. Harrison’s 19th edition page 95

A

Myocardial Ischemia

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3
Q

Determinants of myocardial oxygen consumption. Harrison’s 19th edition page 95

A

Heart rate
Ventricular wall stress
Myocardial contraction

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4
Q

Determinants of myocardial oxygen supply. Harrison’s 19th edition page 95

A

Coronary blood flow

Coronary arterial oxygen content

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5
Q

Ischemic heart disease is most commonly caused by? Harrison’s 19th edition page 96

A

Atheromatous plaque

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6
Q

Duration of myocardial ischemia to result in MI or irreversible cellular injury. Harrison’s 19th edition page 96

A

20 minutes

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7
Q

Ischemic episodes that are typically precipitated by a superimposed increase in oxygen demand during physical exertion and relieved upon resting. Harrison’s 19th edition page 96

A

Stable Angina

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8
Q

Coronary thrombosis triggered by rupture or erosion of one or more atherosclerotic lesions and is characterized as presence or absence of detectable myocardial injury and the presence or absence of ST-segment elevation on the patient’s ECG. Harrison’s 19th edition page 96

A

Unstable ischemic heart disease

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9
Q

Classification of Unstable ischemic heart disease. Harrison’s 19th edition page 96

A

Unstable Angina
Non-ST elevation MI
ST elevation MI

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10
Q

Unstable ischemic heart disease with no detectable myocardial injury. Harrison’s 19th edition page 96

A

Unstable angina

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11
Q

Unstable ischemic heart disease with evidence of myocardial necrosis. Harrison’s 19th edition page 96

A

Non-ST elevation MI (NSTEMI)

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12
Q

Transmural myocardial ischemia caused by a coronary thrombus that is acutely and completely occlusive with ST-segment elevation on ECG and myocardial necrosis. Harrison’s 19th edition page 96

A

ST elevation MI (STEMI)

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13
Q

Ischemia precipitated by acute coronary atherothrombosis. Harrison’s 19th edition page 96

A

Acute Coronary Syndrome

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14
Q

Acute Coronary Syndrome. Harrison’s 19th edition page 96

A

Unstable angina
NSTEMI
STEMI

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15
Q

Myocardial Ischemia precipitated by exertion, cold or stress. Harrison’s 19th edition page 97

A

Stable angina

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16
Q

Exertional chest discomfort that occurs at increased frequency with progressively lower intensity of physical activity or even at rest. Harrison’s 19th edition page 97

A

Unstable angina

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17
Q

Exertional chest discomfort that usually begins gradually and reaches its maximal intensity over a period of minutes before dissipating within several minutes with rest or with nitroglycerin. Harrison’s 19th edition page 97

A

Stable angina

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18
Q

Chest discomfort that is typically severe and prolonged usually lasting >30mins and is not relieved by rest. Harrison’s 19th edition page 97

A

Myocardial infarction

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19
Q

Chest discomfort characteristic of myocardial ischemia. Harrison’s 19th edition page 97

A 
Aching
Heavy
Squeezing
Crushing
Constricting
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20
Q

Usual site of chest discomfort in Myocardial ischemia. Harrison’s 19th edition page 97

A

Retrosternal

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21
Q

Usual site of radiation of the chest discomfort in Myocardial ischemia. Harrison’s 19th edition page 97

A 
Ulnar surface of the left arm
Right arms
Both arms
Neck
Jaw
Shoulders
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22
Q

Associated features in Myocardial Ischemia. Harrison’s 19th edition page 96

A

S4 gallop (pain)
Mitral regurgitation (pain)
S3 (severe ischemia or complication)
Rales (severe ischemia or complication)

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23
Q

Pathophysiology of referred cardiac pain. Harrison’s 19th edition page 97

A

Cardiac sympathetic afferent impulses converge with impulses from somatic thoracic structures.

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24
Q

Pathophysiology of anginal pain radiating to the neck. Harrison’s 19th edition page 97

A

Cardiac vagal afferent fibers synapse in the nucleus tractus solitatrius (medulla) descend to the upper cervical spinothalamic tract

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25
Radiation to right arm or shoulder. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Increased
26
Described as pressure. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Increased
27
Inframammary location | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Decreased
28
Associated with diaphoresis. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Increased
29
Described as pleuritic. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Decreased
30
Described as sharp. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Decreased
31
Radiation to both arms or shoulders. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Increased
32
Reproducible with palpation. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Decreased
33
Associated with exertion. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Increased
34
Radiation to left arm. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Increased
35
Associated with nausea or vomiting. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Increased
36
Worse than previous angina or similar to previous MI. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Increased
37
Described as positional. | Increased or decreased likelihood of AMI? Harrison’s 19th edition page 99
Decreased
38
Characteristics of chest pain that increases the likelihood of AMI. Harrison’s 19th edition page 99
``` Radiation to the right arm or shoulder Radiation to both arms or shoulder Associated with exertion Radiation to the left arm Associated with diaphoresis Associated with nausea and vomiting Worse than previous angina or similar to previous MI Described as pressure ```
39
Characteristics of chest pain that increases the likelihood of AMI. Harrison’s 19th edition page 99
``` Inframammary location Reproducible with palpation Described as sharp Described as positional Described as pleuritic ```
40
Chest pain in pericarditis. Harrison’s 19th edition page 97
Associated with pleural inflammation Pleuritic Exacerbated by breathing, coughing and changes in position
41
Pathophysiology of radiation pain to the shoulder and neck. Harrison’s 19th edition page 97
Overlapping supply of central diaphragm via phrenic nerve with somatic sensory fibers from 3rd and 5th cervical segments
42
Pathophysiology of radiation pain to the upper abdomen. Harrison’s 19th edition page 97
Lateral diaphragm
43
Form of cardiomyopathy that is triggered by an emotional or physical stressful event and may mimic AMI. Usually seen in women > 50 years of age. Harrison’s 19th edition page 97
Takotsubo cardiomyopathy
44
5 high risk conditions with acute chest pain that warrants urgent evaluation and management. Harrison’s 19th edition page 98
``` ACS Acute aortic syndrome Pulmonary embolism Tension pneumothorax Pericarditis with tamponade ```
45
Involves a tear in the aortic intima resulting in separation of the media and creation of a separate “false” lumen. Harrison’s 19th edition page 97
Aortic Dissection
46
Ulceration of an aortic atheromatous plaque that extends through the intima and into the aortic media, with potential to initiate an intramedial dissection or rupture into the adventitia. Harrison’s 19th edition page 97
Penetrating ulcer
47
Aortic wall hematoma with no demonstrable intimal flap, no radiologically apparent intimal tear, and no false lumen. Harrison’s 19th edition page 97
Intramural hematoma
48
Cause of intramural hematoma. Harrison’s 19th edition page 97
Rupture of the vasa vasorum | Penetrating ulcer
49
Pain of acute aortic syndrome involving the ascending aorta. Harrison’s 19th edition page 97
Midline of the anterior chest
50
Pain of descending aortic syndrome. Harrison’s 19th edition page 97
Pain in the back
51
Major complications of proximal aortic dissections. Harrison’s 19th edition page 97
MI due to compromise of the aortic ostia of the coronary arteries Acute aortic insufficiency due to disruption of the aortic valve Pericardial tamponade due to rupture of the hematoma in to the pericardial space
52
Causes of chest discomfort in pulmonary embolism. Harrison’s 19th edition page 98
Involvement of the pleural surface of the lung adjacent to a resultant pulmonary infarction Distention of the pulmonary artery Right ventricular wall stress and/or Subendocardial ischemia related to acute pulmonary hypertension.
53
Associated symptoms in Massive or submassive pulmonary embolism. Harrison’s 19th edition page 98
Syncope Hypotension Right heart failure
54
Chest discomfort in small pulmonary embolism. Harrison’s 19th edition page 98
Lateral and pleuritic
55
Chest discomfort in massive pulmonary embolism. Harrison’s 19th edition page 98
Severe substernal pain that may mimic MI
56
Risk factors for for pneumothorax. Harrison’s 19th edition page 98
Male Smoking Family history Marfan syndrome
57
Type of pneumothorax that occurs in patients with underlying lung disorders. Harrison’s 19th edition page 98
Secondary spontaneous pneumothorax
58
Caused by trapped intrathoracic air that precipitates hemodynamic collapse. Harrison’s 19th edition page 98
Tension pneumothorax
59
Knifelike pain that is worsened by inspiration or coughing. Harrison’s 19th edition page 98
Pleurisy
60
Most common cause of non traumatic chest discomfort. Harrison’s 19th edition page 98
Gastrointestinal conditions
61
Costochondral junctions. Harrison’s 19th edition page 98
Tietze’s syndrome
62
Relief of angina as they continue at the same or even a greater level of exertion without symptoms. Harrison’s 19th edition page 99
Warm-up angina
63
Angina due to redistribution of blood flow to the splanchnic vasculature after eating. Harrison’s 19th edition page 100
Postprandial angina
64
A delay of __min before relief is obtained after nitroglycerin suggest that the symptoms either are not caused by ischemia. Harrison’s 19th edition page 100
>10mins
65
Activation of the vagal reflex or stimulation of left ventricular receptors that causes nausea and vomiting in the setting of MI. Harrison’s 19th edition page 100
Bezold-Jarisch reflex
66
Clenched fist held against the sternum. Harrison’s 19th edition page 100
Levine’s sign
67
Important manifestation of submassive pulmonary embolism. Harrison’s 19th edition page 100
Sinus tachycardia
68
Preferred biomarker. Harrison’s 19th edition page 101
Cardiac troponin
69
Most useful for identifying pulmonary processes. Harrison’s 19th edition page 101
Chest radiograph
70
ECG should be obtained within ___ of presentation of chest pain. Harrison’s 19th edition page 100
10 mins
71
Provide early detection of MI defining areas of myocardial necrosis accurately. Harrison’s 19th edition page 102
Gadolinium-enhanced Cardiac Magnetic Resonance
72
Employed for completion of risk stratification of patients who have undergone an initial evaluation that has not revealed a specific cause of chest discomfort and has identified them as being at low or intermediate risk of ACS. Harrison’s 19th edition page 101
Exercise electrocardiography (“stress testing”)
73
Useful for detecting myocardial ischemia in the absence of STEMI in an ECG. Harrison’s 19th edition page 100
ST-segment depression | Symmetric T-wave inversions at least 0.2mV in depth

Cardiology (2 decks)

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