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CMN574 > Module 1 - Chest Pain/Heart Disease > Flashcards

Module 1 - Chest Pain/Heart Disease Flashcards

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1
Q

Modifiable risk factors for chest pain

A

Lipid disorders
HTN
Cigarette smoking

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2
Q

Nonmodifiable risk factors associated with chest pain

A

Age (older)
Sex (male before menopause)
Family hx of early coronary disease

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3
Q

What can cause chest pain?

A

Cardiovascular disorders
Pulmonary disorders
Pleural disorders
Musculoskeletal disease
GI disorders (esophageal disorders)
Herpes zoster
Cocaine use
Anxiety states

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4
Q

Life threatening causes of chest pain

A

acute coronary syndrome (ACS)
Pericarditis
Aortic dissection
Vasospastic angina
pulmonary embolism
Esophageal perforation

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5
Q

Conditions (diseases) associated with increased risk of coronary artery disease

A

-SLE
-RA
-Reduced estimated GFR
-HIV infection
-Precocious ACS (acute coronary syndrome)

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6
Q

Chest Pain: PE
-What sx do patients present with?

A

SOB, chest pain, anxious

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7
Q

VTE risk factors

A

-Cancer
-Trauma
-Recent surgery
-prolonged immobilization
-Pregnancy
-oral contraceptives
-family hx and prior hx of VTE
-COVID

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8
Q

Chest Pain: PE
-other conditions associated with increased risk of PE

A

-HF
-COPD
-Sickle cell anemia
-Carbon monoxide poisoning
-Increased circulatory volume
-COVID

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9
Q

Chest Pain: PE
-clinical findings: Sx

A

-dull, aching sensation of “pressure,” “tightness,” “squeezing,” or “gas,” rather than as sharp or spasmodic
-pain does not reach maximum intensity in seconds
-Ischemic sx usually subside within 5-20 minutes but may last longer
-Progressive sx or sx at rest may represent unstable angina

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10
Q

Chest Pain: MI
-how long does it take for pain to subside (stable angina)

A

5-20 minutes, but could last longer

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11
Q

Chest Pain: MI (stable angina)
-Is pain onset gradual or acute?

A

Gradual

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12
Q

Chest Pain: MI
-what is pain usually accompanied by?

A

anxiety and uneasiness

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13
Q

Chest Pain: MI
-what is usually normal when these patients present?

A

Physical assessment

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14
Q

Chest Pain: MI
-where is the pain located?

A

Retrosternal or left precordial

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15
Q

Chest Pain: MI
-where does pain tend to refer to?

A

-Throat, lower jaw, shoulders, inner arms, upper abd, back

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16
Q

Chest Pain: MI
-what can ischemic pain be cause/exacerbated by?

A

-exertion
-cold temp
-meals
-stress
-combination of these factors

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17
Q

Chest Pain: MI (stable angina)
-what is ischemic pain usually relieved by?

A

Rest (and nitroglycerine)

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18
Q

Atypical presentations of ACS are more common in:

A

Older adults
DM
Women

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19
Q

Chest Pain: other sx that are associated with ACS

A

SOB
Dizziness
Feeling of impending doom
Vagal sx (nausea and diaphoresis)
Fatigue is a common presenting complaint in older persons
Vomiting strongly associated with acute

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20
Q

What ACS symptom is strongly associated with an acute situation?

A

Vomiting

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21
Q

What ACS sx is a common presenting complaint in older persons?

A

Fatigue

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22
Q

Clinical features of acute MI:
-from hx (sx)

A

-chest pain that radiates to left, right, or both arms
-Diaphoresis
-N/V

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23
Q

Clinical features of acute MI:
-From physical examination

A

-Auscultate for third heart sound
-systolic BP <=80mmHg
-Pulonary crackles auscultated

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24
Q

Clinical features of acute MI:
-from ECG

A

-Any ST-segment elevation greater than or equal to 1mm
-Any ST depression
-Any Q wave
-Any conduction defect
-New conduction defect

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25
What clinical findings and risk factors are most suggestive of ACS?
-prior abnormal stress test -Peripheral arterial disease -Pain radiating in both arms
26
ECG findings associated with ACS
-ST-segment depression -any evidence of ischemia -risk scores from hx, ECG, age, RF performed well in detecting ACS
27
Chest Pain: Pericarditis -What position is pain worse?
greater when supine
28
Chest Pain: Pericarditis -What makes pain increase?
-Increases with breathing, coughing, or swallowing
29
Chest Pain: Pleuritic chest pain -ischemic or not ischemic? -what does pain with palpation indicate?
-not ischemic -musculoskeletal cause
30
Chest Pain: aortic dissection -abrupt or gradual? -sx -where does pain radiate?
-abrupt -tearing pain of greater intensity -back
31
Chest Pain: PE -how often is chest pain present with PE? -what is the chief objective during evaluation of these patients?
-75% of cases -assess pt's clinical risk for VTE based on medical hx and associated sx and signs
32
Chest Pain: Rupture of thoracic esophagus -What can cause this pain?
-Iatrogenically (induced unintentionally by a physician or surgeon, by medical treatment, or diagnostic procedures) Secondary to vomiting
33
Should the physical examination be used as a sole basis for ruling in or out ACS diagnoses?
NO
34
Chest Pain: aortic dissection -aortic dissection can result in? -commonly has comorbidity of?
1. differential BPs (greater than 20mmHg) 2. Pulse amplitude deficits 3. New diastolic murmur -HTN with systolic BP less than 100mmHg
35
Cardiac friction rub -what does this represent? -when can this best be heard? -what needs to be excluded in all pts?
-Pericarditis -sitting forward at end-expiration -tamponade
36
Chest Pain: diagnostic studies
-ECG -exercise stress test -chest radiography -stress ECG -high-sensitivity troponin assay
37
Chest Pain: ECG findings with ACS
-ST-segment elevation is strongest predictor of acute MI -Q wave
38
Chest Pain: exercise stress test -who is this used with? -what provider oversees this?
-clinically stable pts with CV disease risk factors, normal ECG, normal cardiac biomarkers, and no alternative dx (i.e. GERD or costochondritis) -cardiologist
39
Chest Pain: Chest radiography -is this even useful in evaluation of chest pain? -when is this always indicated? -what is consistent with esophageal perforation?
-YES! useful in eval of chest pain -ALWAYS indicated when cough or SOB accompanies chest pain -pneumomediastinum or new pleural effusion
40
Chest Pain: stress echocardiography -who oversees this test modality?
cardiology
41
Chest Pain: High-sensitivity troponin assay -what does this determine? -what is this the highest predictive value for?
-rapidly determines whether patient with chest pain has low risk (can be discharged from ED) -Chest pain, ischemia on ECG, hx of ischemic heart disease
42
Chest Pain: PE -what is the diagnostic test that is helpful?
D-dimer
43
Chest Pain: panic disorder -how common is this disorder in causing pain (%)? -features that correlate with inc likelihood of panic disorder?
-25% of cases present to ED -Absence of CAD, atypical quality of chest pain, female sex, younger age, high level of self-reported anxiety, depression associated with recurrent chest pain w/ or w/o CAD
44
Chest Pain: treatment -what is treatment guided by?
-Guided by underlying etiology
45
What are the most common sx of heart disease?
chest pain dyspnea palpitations syncope or presyncope fatigue
46
What other things can cause chest pain?
pulmonary pleural musculoskeletal esophageal or GI disorders anxiety states
47
What represents unstable angina? (what sx?)
progressive sx or sx at rest
48
Is true angina related to position, respiration? Is it elicited by chest palpitations?
-NO -NO
49
what can mask sx of chest pain in women?
depression
50
What is a HEART score? What does it determine?
-history, ECG, age, RF, troponin -distinguishes coronary chest pain from noncoronary chest pain
51
what two items improve sensitivity and specificity of diagnosing an acute coronary syndrome?
HEART score and troponin level
52
Other causes of chest pain:
-hypertrophy of either ventricle -myocarditis, pulmonary HTN, mitral valve prolapse -Pericarditis -Pleuritic chest pain -aortic dissection
53
NYHA Functional Classification of Heart Disease -Class I
no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, dyspnea, or anginal pain
54
NYHA Functional Classification of Heart Disease -Class 2
slight limitation of physical activity. Ordinary physical activity results in sx
55
NYHA Functional Classification of Heart Disease -Class 3
marked limitation of physical activity; comfortable at rest, but less than ordinary activity causes sx
56
NYHA Functional Classification of Heart Disease -Class 4
unable to engage in any physical activity without discomfort; sx may be present even at rest
57
NYHA Functional Classification of Heart Disease -Class 5
used by some experts to describe sx that are atypical and can occur either at rest or with exertion
58
what is the preferred diuretic used to heart disease?
chlorthalidone
59
what can the ECG show us related to heart failure?
valvular abnormalities congenital abnormalities chamber size/hypertrophy presence of pericardial effusions
60
on ECG, what is indicative of MI or ischemia?
ST changes or T wave changes
61
what lab has a major role in defining cardiac risk factors?
CMP: serum lipid levels, serum human c-reactive protein level, serum creatinine
62
what does serum BNP and NT-proBNP levels tell you?
helps determine if dx is congestive heart failure; can determine if congestive HF is being treated well enough -quantitates the severity of heart failure
63
What inflammatory marker is elevated with CAD?
CRP (hsCRP)
64
*Causes of HF
-aging -systemic HTN - leads to left ventricular hypertrophy -CAD - ischemia, MI, death of cardiac muscle with loss of ventricular wall motion -cardiomyopathy -tachyarrhythmias -valvular lesions, myocardial ischemia, uncontrolled HTN, arrhythmias, alc/drug induced myocardial depression, hypothyroidism, intracardiac shunt
65
*cardioselective BB
atenolol, bisoprolol, metoprolol, etc. NOT propranolol, labetalol, carvedilol, pindolol
66
What NYHA classification describes orthopnea and paroxysmal nocturnal dyspnea?
Class IV
67
Murmurs: define stenosis
valve that is stuck shut
68
Murmurs: define regurgitation
leaking valve; insufficient
69
Murmurs: where is the aortic valve auscultated?
R 2nd intercostal space right of sternal border
70
Murmurs: where is the pulmonic valve auscultated?
left 2nd intercostal space left of sternal border
71
Murmurs: where is the tricuspid valve auscultated?
left 5th intercostal space left of sternal border
72
Murmurs: where is the mitral valve auscultated?
apex (PMI) - left intercostal space midclavicular line
73
*PMI, high pitched sound. What murmur is this?
Mitral, regurgitation
74
What valves are open during systole?
Aortic and pulmonic
75
What valves are open during diastole?
Tricuspid and mitral
76
What heart sound does systole correlate with?
S1, lub
77
What heart sound correlates with diastole?
S2, dub
78
What sound does a stenotic valve make?
low pitched, harsh quality
79
What sound does a regurgitant valve make?
high pitched flowing quality
80
*What does a CHADVASC score of 3 indicate for tx?
Woman; anticoagulation therapy; oral anticoagulation is recommended -DO NOT CHOSE ASPIRIN!!!!!!!!! It is minimally effective and not used for stroke prevention in Afib.
81
CHADVASC scores -when to offer anticoagulation therapy?
>=1 score with additional stroke risk factor women is truthfully >=2 with additional risk factor
82
*What is BNP used to dx?
Degree of HF
83
*When is troponin found in labwork?
MI
84
*What are the directions for sublingual nitroglycerin use?
Can take sublingually every 5 minutes at onset of pain, 3x
85
*What betablocker is the first line antianginal?
atenolol (cardioselective beta blockers); bisoprolo, metoprolol
86
*What is the first line therapy for HFrEF?
ACE-I (ARB) + Diuretic?? *BB *MRA
87
HFpEF -percent ejection fraction
>40%
88
HFrEF -percent ejection fraction
<40%
89
*if resistant to diuretic, what should you do?
Add HCTZ, chlorthalidone, indapamide (thiazide diuretic) to current diuretic -administer for short duration during acute phase, with loop diuretic for synergistic effect
90
*What arrhythmia has QRS irregularly irregular?
AFIB
91
*What lab level should you watch on ACE-I or ARB?
K
92
*what are we concerned about with spironolactone?
concern for hyperkalemia
93
*If patient is on ARNI, what knowledge do we need to know?
Must have been able to tolerate high dose ACE-I/ARB
94
*What common SE of ACE-I makes people stop the med?
Cough
95
*What is the goal INR for patient on Warfarin?
Between 2-3
96
*What betablockers are contraindicated with asthma?
noncardioselective: carvedilol (coreg), metoprolol, propranolol
97
*What else does an ACE-I protect?
The Kidneys! Protective for diabetes.
98
* What has the highest impact on CAD? -elevated HDL -elevated LDL -low triglycerides
-elevated LDL
99
ARNI is first line if:
-Stable mod-mild reduced EF -BNP elevated -hospitalized w/ HF in <=12MO -systolic BP >100, GFR >30

CMN574 (6 decks)

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