Chest Pain & Pulmonary - Module 5 Flashcards
(50 cards)
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?
Psychogenic
Clinical Presentation - Duration
If the chest pain lasts only seconds or has been constant for weeks, it is NOT ___________.
cardiac
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
