MHD - Lec # 8 - Clinical Approach to chest pain Flashcards Preview

PHARM/MHD - Exam #4 > MHD - Lec # 8 - Clinical Approach to chest pain > Flashcards

Flashcards in MHD - Lec # 8 - Clinical Approach to chest pain Deck (17):
1

What are the 4 killer chest pains?

1. Acute coronary syndrome (unstable angina/MI)
2. Pulmonary Embolism
3. Aortic Dissection
4. Tension Pneumothorax

2

What are the 3 syndromes of Acute Coronary syndrome?

Unstable Angina
NSTEMI
STEMI

3

Widened mediastinum and pleural effusion are characteristic of ______ ______.

Aortic Dissection

- sudden, tearing chest pain that radiates to the back

4

What are some physical symptoms of acute CAD

Pallor
Sweating
Anxiety
Tachycardia
Rise in blood pressure
S4 gallop
Mitral regurgitation murmur
Paradoxically split S2
Pulsus alternans
(Pulsus alternans indicates impending LV failure and cardiogenic shock.)

5

What are some indications for a stress test

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

6

An EKG is a specific or sensitive test?

SPECIFIC
(85%; sensitivity is 70%)

- SPIN
- if positive rules IN disease

7

What is IHSS? (Idiopathic hypertrophic sub aortic stenosis)

A cardiomyopathy characterized by marked hypertrophy of the left ventricle with asymmetrical hypertrophy of the IV septum out of proportion to the LV free wall (ASH), often resulting in a dynamic obstruction of the LV outflow tract.

8

Classify Debakey Type 1,2, and 3 aortic dissection

Which can be corrected with surgery? Which is managed by medicine?

(stanford type A = 1 & 2)
1 – tear in ascending aorta, dissection moves distally (both)

2- originates & confined to ascending aorta

1and 2 = REQUIRE IMMEDIATE SURGERY!!!




(stanford type B)

3 = tear below the left subclavian
extend distally
difficult operation & generally managed medically via BP
= thoracic aorta


Stanford Type A - all dissections involving the proximal aorta

Stanford Type B - all dissections involving the distal aorta

9

What are the 3 predisposing factors leading to Aortic Dissection?

HYPERTENSION
HYPERTENSION
HYPERTENSION!!!

HTN!!!!!!!! (most common)
pregnancy
congenital

-bicuspid aortic valve,
- coarctation,
- Marfan, Ehlers-Danlos

Widened Mediastinum on chest xray

10

Describe the pain & signs of Aortic dissection

Pain:
Cataclysmic onset!!!
Most severe at onset, “tearing”, “stabbing” (in contrast, angina is slow progressing pain)

Tendency to migrate

Anterior thorax (proximal); interscapular (distal)
_________________

Signs:
Pulse deficit (proximal), aortic regurgitation (proximal)
Neurological deficits (proximal) – CVA, paraparesis, peripheral neuropathy, vasovagal

11

Of the non-cardiac causes of chest pain, which has the highest percentage of mortality/morbidity?

Pulmonary embolism has the greatest morbidity and mortality of the listed non-cardiac causes of chest pain.

12

What are some GI causes of chest pain

Gastrointestinal
Gastroesophageal reflux
Diffuse esophageal spasm
Cholecystitis and cholelithiasis

13

What are some Pulmonary causes of chest pain

Pulmonary
Pulmonary hypertension
Pneumothoraz
Pulmonary embolism

14

What are some mental causes of chest pain

Emotional
Anxiety states
(hyperventilation)
Depression

15

What are some Neuromuscular causes of chest pain

Neuromuscular
Herpes zoster
Cervical arthritis
Chest wall pain and tenderness

16

What is a great test to rule out a PE?

D – Dimer - great test to rule out
negative= real negative predictive value
(sensitive)

if positive it does NOT help us
- need CXR usually

17

What are some physical signs of calf vein thrombosis

- ASSYMMETRIC SWELLING associated with PAIN in the area of the calf below the obstruction