L3 - Chest Pain

Question 1

What does HBP stand for?

Answer 1

High blood pressure

Question 2

What does GTN stand for?

Answer 2

Glycerinetrinitrate

Question 3

How often is chest pain diagnosed?

Answer 3

Chest pain is not a diagnosis. It is a symptom

Diagnosis = chest pain due to X

Question 4

What is Levine’s Sign?

Answer 4

When a person grips their chest with a fist during chest pain

It suggests cardiac involvement

Question 5

When do you do ECG?

Answer 5

Once during chest pain & once after

Question 6

How does the ECG appear during cardiac related chest pain?

Answer 6

ST segment elevation or depression

Question 7

How to decrease HR & BP?

Answer 7

Beta Blockers

Question 8

How to decrease LV stiffness & LVEDP?

Answer 8

Nitro –> decreased venous return to heart

Question 9

Sharp chest pain would suggest what?

Answer 9

Non-cardiac

Question 10

Squeezing/pressing chest pain would suggest what?

Answer 10

Cardiac

Question 11

Aching chest pain would suggest what?

Answer 11

Cardiac

Question 12

Dull chest pain would suggest what?

Answer 12

Cardiac

Question 13

Burning chest pain would suggest what?

Answer 13

Cardiac (exception = GERD)

Question 14

Visceral/deep chest pain would suggest what?

Answer 14

Cardiac (exception = GERD)

Question 15

Superficial chest pain would suggest what?

Answer 15

Non-cardiac

Question 16

Substernal chest pain would suggest what?

Answer 16

Cardiac (exception = GERD)

Question 17

Severe chest pain would suggest what?

Answer 17

Cardiac more likely but not a certainty

Question 18

Mild chest pain would suggest what?

Answer 18

Non-cardiac but not a certainty

Question 19

Chest pain for seconds would suggest what?

Answer 19

Non-cardiac

Question 20

Chest pain for minutes would suggest what?

Answer 20

Cardiac

Question 21

Chest pain for hours would suggest what?

Answer 21

Non-cardiac, but MI can present with this long of pain

Question 22

Chest pain associated with movement of the neck, arm or shoulder would suggest what?

Answer 22

Non-cardiac but not a certainty

Question 23

What would random (no precipitating factor) chest pain suggest?

Answer 23

Doesn’t fit the classic picture of cardiac chest pain, but doesn’t really point strongly one way or the other

Question 24

Chest pain that follows exertion would suggest what?

Answer 24

Cardiac

Question 25

| Chest pain following a meal would suggest what?

Answer 25

```

Cardiac

or

Esophogeal Spasm

```

Question 26

Chest pain following exposure to heat or cold would suggest what?

Answer 26

Cardiac

Question 27

Chest pain following an emotional situation would suggest what?

Answer 27

Cardiac Adrenaline rush

Question 28

Chest pain relieved by nitrates would suggest what?

Answer 28

Cardiac

Question 29

Chest pain that is alleviated by eating suggests what?

Answer 29

Non-cardiac

Question 30

Chest pain alleviated by antacids suggest what?

Answer 30

Non-cardiac

Question 31

Chest pain with breathlessness would suggest what?

Answer 31

Cardiac (high pressure builds up into pulmonary HTN)

Question 32

Chest pain that occurs while sleeping suggests what?

Answer 32

Cardiac more likely More venous return when lie down

Question 33

Chest pain that occurs early in the morning suggests what?

Answer 33

Cardiac more likely Platelets stickier during morning

Question 34

How to decrease platelet adhesion?

Answer 34

Baby aspirin

Question 35

How do you do an ECG if the patient isn't having chest pain at that moment?

Answer 35

Stress test (treadmill) ---> try to induce cardiac event

Question 36

ST elevation on an ECG suggests what?

Answer 36

MI

Question 37

Visceral substernal epigastric pain that lasts 30 minutes. Does not radiate. Exacerbated by not eating & recumbency (resting). Alleviated with antacids. Diagnosis?

Answer 37

GERD

Question 38

What non-cardiac cause mimics cardiac angina most closely?

Answer 38

Esophogeal spasm

Question 39

Visceral substernal epigastric pain & burning for hours. Brought on by certain foods or not eating. Alleviated by antacids. Diagnosis?

Answer 39

Peptic Ulcer

Question 40

Superficial arm, neck & chest pain that is not relieved by rest. Alleviated by analgesia. Pain worsens with head, arm or shoulder movement. Pain worsens due to palpation. Diagnosis?

Answer 40

Cervical disk problem & nerve compression

Question 41

Superficial tenderness exacerbated by movement or palpation located on the chest. Alleviated with time or analgesia. Diagnosis?

Answer 41

Musculoskeletal

Question 42

Visceral substernal pain that lasts for a few minutes following an emotion situation. Facial paresthesia (tingling). Alleviated by removing emotional stimulus. Diagnosis?

Answer 42

Emotional hyperventilation

Question 43

Severe visceral substernal chest pain lasting hours to days. Spontaneous provocation & relief by nitro. Diagnosis?

Answer 43

MI

Question 44

When do you give morphine for chest pain?

Answer 44

Not first. It will alleviate any pain so it gives you no info. Give nitro first, then IV analgesics

Question 45

Substernal poorly localized and radiating chest pain that is brought on by effort or emotion lasting 5-15 minutes. Alleviated with nitro or rest. Diagnosis?

Answer 45

Effort Angina

Question 46

When is effort angina the worst?

Answer 46

First episode is most vivid

Question 47

Poorly localized substernal visceral pain that radiates and arises spontaneously. Lasts 5-15 minutes. Alleviated by nitro. Diagnosis?

Answer 47

Rest angina

Question 48

Visceral substernal radiating pain that lasts 5-60 minutes. Arises spontaneously or in relation to exercise, food or cold. Alleviated by nitro. Diagnosis?

Answer 48

Esophogeal spasm but really similar to cardiac cause

Question 49

How to differentiate GERD and Peptic ulcers?

Answer 49

Peptic ulcers pain generally last hours while GERD generally lasts for about a half hour