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

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

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

2

What are the emergent causes of chest pain?

Acute coronary syndromes
Pulmonary embolism
Aortic dissection
Tension pneumothorax

3

List the common cardiac causes of chest pain

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

4

Describe the 3 locations of pain associated with chest pain

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

5

How is cardiac chest pain classically described?

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

6

What are the physical signs of acute CAD?

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

7

What are the 3 categories of acute coronary syndrome?

Unstable angina
NSTEMI
STEMI

8

Describe how daily activities can trigger coronary thrombosis

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

What is the #1 diagnostic tool for acute MI?

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

10

What are the ECG features of an acute infarction?

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

11

What conditions often appear like an MI on ECG?

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

12

How does a posterior MI appear on ECG?

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

13

What is a troponin lab test used for?

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

14

What is stable angina?

Chest pain occurring with exertion in a predictable and consistent way

15

Describe the sequence of ischemic changes that occur following an occlusion

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

16

Describe the Canadian cardiovascular society classification system for angina pectoris

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

What are the indications for a treadmill stress test?

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

18

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

Upsloping ST segment

19

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

Horizontal or downsloping ST segment

20

How does pericarditis appear on an ECG?

Diffuse ST elevation
PR depression

21

Describe the hemodynamics of aortic stenosis

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

22

What is IHSS?

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

23

What are the GI causes of chest pain?

GERD
Esophageal spasm
Cholecystitis

24

What are the pulmonary causes of chest pain?

Pulmonary hypertension
Pneumothorax
Pulmonary embolism

25

What are the emotional causes of chest pain?

Anxiety
Depression

26

What are the neuromuscular causes of chest pain?

Herpes zoster
Cervical arthritis
Chest wall pain/tenderness

27

What is a pneumothorax?

Air in the pleural space

28

How does tension pneumothroax become fatal?

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

29

What is the gold standard for diagnosing CAD?

Angiography