Chest Pain & Pulmonary - Module 5 Flashcards Preview

NM703 Primary Care of the Woman > Chest Pain & Pulmonary - Module 5 > Flashcards

Flashcards in Chest Pain & Pulmonary - Module 5 Deck (50)
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What are the most common causes of non-cardiac chest pain?

Muscoloskeletal, gastrointestinal, psychiatric, and pulmonary disease


How does life span relate to chest pain?

Younger patients have more benign underlying conditions. Older patieints (especially with comorbidities) are more likely to have serious causes. ALL patients should have cardiac & life-threatening non-cardiac conditions ruled out first.


What are nonmodifiable risk factors for coronary artery disease (CAD)?

Gender, age( male >45; female >55), family history of premature CHD


What are modifiable risk factors for CAD?

Smoking, dyslipidemia (low HDL: 130) , diabetes mellitus, increased waist to hip ratio, physical inactivity, poor diet, psychosocial stress, poor dental health, and hypertension


What determines the risk for cardiovascular events?

The composition, morphology and stability of the coronary artery plaque. NOT the degree of plaque stenosis.


When should the patient with chest pain be sent to the ER?

Hemodynamic instability; positive ancillary studies (ECG, pulse ox, CBC, ABG, serum cardiac biomarkers, CXR,Echo, stress test, angiography) or high clinical suspicion.


Clinical Presentation - Cardiac Chest Pain Quality:

Vise-like pressure; constricting.


Clinical Presentation - Location:
What does pain that localizes to a small area of the chest suggest?

Pleural or chest wall involvement


Clinical Presentation - Intensity:
What causes an abrupt onset of pain with the greatest intensity at the beginning?

Aortic dissection, pneumothorax, or pulmonary embolism.


Clinical Presentation - Intensity:
What causes a more gradual onset of pain?

Ischemic chest pain


Clinical Presentation - Intensity:
When is the onset of pain more vague?



Clinical Presentation - Duration
If the chest pain lasts only seconds or has been constant for weeks, it is NOT ___________.



Clinical Presentation - Aggravation
Symptoms related to eating (dysphagia, odynophagia, & heartburn) suggest:

Esophageal chest pain


Clinical Presentation - Aggravation
Pain that worsens with exercise is reflective of:

cardiac ischemia


Clinical Presentation - Aggravation
Pain aggravated by position changes, deep breathing, or cough:

Musculoskeletal or pleural disorder


Clinical Presentation - Alleviation
Repeated relief from antacids or food:

Gastrointestinal source.


Clinical Presentation - Alleviation
Relief with nitroglycerin:

Esophageal and cardiac causes.


Clinical Presentation - Non-Cardiac Chest Pain Quality:

Sharp, stabbing, or knife-like pain


What words might a patient use to describe angina?

Variable; pressure, heaviness, aching, constriction, tightness, squeezing,numbness, or burning sensation.


Exam findings of MI:

1) Chest pain: pressure, heavinesss, squeezing, crushing, aching
2) Nausea & vomiting
3) Diaphoresis
4) Dyspnea
5) Possible atrial gallop (s4)
6) hypertension


NSTEMI (non-ST-segment elevation MI) is most often caused by _______________.

coronary artery narrowing caused by a non-occlusive thrombus (developed from a ruptured atherosclerotic plaque).


STEMI (ST-sement elevation MI) is most often caused _____________________.

when an atherosclerotic plaque ruptures, resulting in coronary artery occlusion.


Are ST-segment elevations or history and presenting symptoms more diagnostic of MI?

History and presenting sx


Difference between men & women presenting with MI?

Women will many times present with c/o indigestion. Women 20% mortality; men 8% mortality


Hx & Sx: recent orthopeadic surgery, sharp anterior chest pain, hemoptysis, RR-24, slightly decreased excursion and breath sounds at R base; Negative for chills, fever, orthopnea, calf pain

PE; Needs CXR; Send to ER


Key indicators for Dx of Asthma:

1) Wheezing
2) Hx of one: cough, recurrent wheeze, recurrent diff in breathing, recurrent chest tightness
3) Sx occur or worsen with : exercise, viral infection, inhalant allergens, irritants, changes in weather, strong emotional expression, menstrual cycles
4) Sx occur or worsen at night.


Dx of asthma is based on ___________, ____________, and ________________ ____________ especially _________________.

history, physical, diagnostic tests, spirometery


What is FEV1 and how does it change in mild asthma?

Forced expiratory volume at 1 second. It is reduced in mild asthma.


Intermittent asthma: Step 1 Tx?

SABA (short acting beta agonist - ex. albuterol) PRN; Short course of oral systemic corticosteroids may be needed


Persistent Asthma: Step 2 Tx?

Low dose Inhaled Corticosteroids