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Flashcards in MHD: Chest Pain Deck (29)
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1
Q

What are the most common causes of non-emergent chest pain?

A
Musculoskeletal (36%)
GI (19%)
Cardiac (16%)
Psych (8%)
Pulmonary (5%)
2
Q

What are the emergent causes of chest pain?

A

Acute coronary syndromes
Pulmonary embolism
Aortic dissection
Tension pneumothorax

3
Q

List the common cardiac causes of chest pain

A
Angina
MI
Aortic valve disease
Hypertrophic or congestive cardiomyopathy
Aortic dissection
Pericarditis
Mitral valve prolapse
4
Q

Describe the 3 locations of pain associated with chest pain

A

Most common: substernal

2nd: Epigastric and along the medial left arm
3rd: Neck, right shoulder, medial right arm

5
Q

How is cardiac chest pain classically described?

A

Crushing pain, pressure, tightness

Over 50% of the time this indicates cardiac involvement (30% angina, 24% MI)

6
Q

What are the physical signs of acute CAD?

A

Pallor, sweatting, anxiety, tachycardia, elevated BP, S4 gallop, mitral regurgitation murmur, paradoxically split S2, pulsus alterans

7
Q

What are the 3 categories of acute coronary syndrome?

A

Unstable angina
NSTEMI
STEMI

8
Q

Describe how daily activities can trigger coronary thrombosis

A

A vulnerable atherosclerotic plaque can rupture due to stress.
Minor ruptures can lead to nonocclusive thrombi and unstable angina, or a nonQ MI
Major ruptures can lead to occlusive thrombus and MI or sudden cardiac death

9
Q

What is the #1 diagnostic tool for acute MI?

A

ECG

50% will show typical signs of MI, 40% will be abnormal, but not diagnostic, and 10% will appear normal

10
Q

What are the ECG features of an acute infarction?

A

Elevated ST segments, inverted T waves and the development of Q waves

11
Q

What conditions often appear like an MI on ECG?

A

ECG impostors: Pericarditis, J-point elevation, WPW syndrome

12
Q

How does a posterior MI appear on ECG?

A

Reciprocal changes in the anterior leads (depressed ST segment, tall upright T waves, prominent R waves)

13
Q

What is a troponin lab test used for?

A

Lab test that is specific for cardiac injury ~24 hrs after MI

14
Q

What is stable angina?

A

Chest pain occurring with exertion in a predictable and consistent way

15
Q

Describe the sequence of ischemic changes that occur following an occlusion

A
Relaxation failure
Contraction failure
Increased filling pressure
ECG changes
Angina (~25 seconds after occlusion)
16
Q

Describe the Canadian cardiovascular society classification system for angina pectoris

A

I-IV scale with I and II representing stable angina, III and IV representing unstable angina.
Categories are separated based on the impact of physical activity

17
Q

What are the indications for a treadmill stress test?

A
Evaluation of chest pain
Estimating progress and severity of disease
Evaluation of therapy
Screening for latent coronary disease
Evaluation of arrhythmias
18
Q

Describe the ECG during an exercise stress test of a normal individual

A

Upsloping ST segment

19
Q

Describe the abnormal pathological finding on an ECG during an exercise stress test

A

Horizontal or downsloping ST segment

20
Q

How does pericarditis appear on an ECG?

A

Diffuse ST elevation

PR depression

21
Q

Describe the hemodynamics of aortic stenosis

A

The hardened aortic valve creates an increased pressure in the left ventricle during systole. This presents as a systolic ejection murmur.

22
Q

What is IHSS?

A

Idiopathic hypertrophic subaortic stenosis
Cardiomyopathy with asymmetrical hypertrophy of the intraventricular septum without equivalent hypertrophy of the free wall

23
Q

What are the GI causes of chest pain?

A

GERD
Esophageal spasm
Cholecystitis

24
Q

What are the pulmonary causes of chest pain?

A

Pulmonary hypertension
Pneumothorax
Pulmonary embolism

25
Q

What are the emotional causes of chest pain?

A

Anxiety

Depression

26
Q

What are the neuromuscular causes of chest pain?

A

Herpes zoster
Cervical arthritis
Chest wall pain/tenderness

27
Q

What is a pneumothorax?

A

Air in the pleural space

28
Q

How does tension pneumothroax become fatal?

A

Increased thoracic pressures can prevent blood flow to the heart, decreasing the hearts ability to pump blood and causing shock, rapid death

29
Q

What is the gold standard for diagnosing CAD?

A

Angiography