Flashcards in MHD - Lec # 8 - Clinical Approach to chest pain Deck (17):
What are the 4 killer chest pains?
1. Acute coronary syndrome (unstable angina/MI)
2. Pulmonary Embolism
3. Aortic Dissection
4. Tension Pneumothorax
What are the 3 syndromes of Acute Coronary syndrome?
Widened mediastinum and pleural effusion are characteristic of ______ ______.
- sudden, tearing chest pain that radiates to the back
What are some physical symptoms of acute CAD
Rise in blood pressure
Mitral regurgitation murmur
Paradoxically split S2
(Pulsus alternans indicates impending LV failure and cardiogenic shock.)
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
An EKG is a specific or sensitive test?
(85%; sensitivity is 70%)
- if positive rules IN disease
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.
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
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
What are the 3 predisposing factors leading to Aortic Dissection?
HTN!!!!!!!! (most common)
-bicuspid aortic valve,
- Marfan, Ehlers-Danlos
Widened Mediastinum on chest xray
Describe the pain & signs of Aortic dissection
Most severe at onset, “tearing”, “stabbing” (in contrast, angina is slow progressing pain)
Tendency to migrate
Anterior thorax (proximal); interscapular (distal)
Pulse deficit (proximal), aortic regurgitation (proximal)
Neurological deficits (proximal) – CVA, paraparesis, peripheral neuropathy, vasovagal
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.
What are some GI causes of chest pain
Diffuse esophageal spasm
Cholecystitis and cholelithiasis
What are some Pulmonary causes of chest pain
What are some mental causes of chest pain
What are some Neuromuscular causes of chest pain
Chest wall pain and tenderness
What is a great test to rule out a PE?
D – Dimer - great test to rule out
negative= real negative predictive value
if positive it does NOT help us
- need CXR usually