Chest Pain (Johnson) Flashcards
What are some non-cardiac causes of chest-pain?
GERD Acute cholecystitis Esophageal motility disorders PE, pneumothroax, pneumonia Lung cancer Cervical/thoracic spine Chest wall strain or trauma
What are some lab tests that might be abnormal due to a STEMI?
CBC: elevated WBC, troponin I, and CKMB
BNP: elevated
What can mimic angina in the absence of CAD?
Aortic insufficiency, aortic stenosis Pulmonary HTN Hypertrophic cardiomyopathy Heart failure Coronary spasm
What are the ‘serious seven’ potentially lethal causes of chest pain?
Myocardial ischemia MI Aortic dissection PE Pneumothorax Esophageal rupture Pericarditis– pericardial effusion/tamponade
When do we usually hear an S4 gallop? What about an S3 gallop?
S4: angina
S3: heart failure
Are cardiac enzymes elevated in an unstable angina?
No– if cardiac enzyme are elevated and EKG reveals ST depression/T-wave inversion this is a NSTEMI
What would be included in a ddx of a STEMI?
Pericarditis, myocarditis
Stress induced cardiomyopathy
Early ventricular repolarization
What supplies the inferior wall?
What might an occlusion here cause?
RCA– an occlusion here might cause a mitral regurgitation murmur due to papillary muscle dysfunction
How do we tx an unstable STEMI?
NTG, B-blocker, ASA, statin
Consider ACEi
Platelet antagonist
What are some physical exam findings associated with CVD? (6)
Xanthelasma Nicotine stains and odors Bruits S4 and S3 gallops Mitral regurgitation Diaphoresis
What pathology might be elevated by chest pain that feels better when leaning over?
Pericarditis
How is stress testing performed after a suspected STEMI?
Treadmills exercise test is the initial test if available with stress echocardiogram. When exercise is not tolerable, pharmacological testing is done instead– vasodilator nuclear perfusion > dobutamine nuclear perfusion > dobutamine echocardiogram
What is the most common pathogenesis of mitral regurgitation?
Papillary muscle dysfunction
How do we tx a stable angina?
Lifestyle modifications NTG for chest pain (every 5 min x 3) Long acting nitrates B-blocker CCB Statin Aspirin ACEi if EF<40%
What are some non-chest pain sx of IHD?
Dyspnea Excessive fatigue/weakness Dizziness/syncope Nausea/indigestion/heartburn Neck-jaw pain Diaphoresis
