Chest Pain (Continued)

  1. Rapid eval for potential Acute Coronary Syndromes (ACS): Important history
    • Onset and character of pain
    • Prior History of CAD.
  2. How can troponin be used to rule out MI
    Normal serial troponin measurements 10 hours after symptom onset can essentially exclude MI. Normal troponins can inform short term prognosis: only 1 in 300 patients with normal ECG and a normal troponin I level 6 hours after chest pain onset will have an adverse cardiac outcome in the next 30 days.
  3. How is serum myoglobin helpful in rapidly ruling out MI
    when serial measurements remain within normal range and do not double over 2 hours time, within 6 hours of symptom onset. Only about 3% of those in the ED without change in myoglobin will have an MI.
  4. ECG in pulmonary embolism has, in order of positive predictive value:
    • 1. Sinus tachycardia
    • 2. S1Q3T3 pattern
    • 3. Rightward axis deviation
    • 4. Right bundle branch block
    • 5. ST depression in rt precordial leads
    • 6. p-pulmonale
    • 7. ST elevation in lead III.
  5. Diagonal ear lobe creases are associated with what diagnosis?
  6. Reduction or dissappearance of the brachial and carotid pulses is associated with what diagnosis?
    • Aortic dissection.
    • Also, inequality of blood pressure in both arms of patients with chest pain.
  7. Exam findings that help rule in vascular disease:
    diminished or absent pedal pulses, or audible bruit. Leg complaints, absence of femoral pulse, presence of femoral artery bruit.
  8. RED FLAG: Mediastinal widening is associated with what diagnosis?
    Aortic dissection with severe tearing or ripping pain.
  9. RED FLAG: Arrhythmia and/or chest pain in younger patient
    Is associated with what diagnosis?
    cocaine abuse
  10. RED FLAG: new systolic mitral murmur
    is associated with what diagnosis?
    ruptured papillary muscle
  11. RED FLAG: ECG changes, especially ST segment elevation or new left bundle branch block.
    Is associated with what diagnosis?
  12. Red Flag: tachycardia, tachypnea, hypoxia
    Is associated with what diagnosis?
    pulmonary embolism
  13. Red Flag: hypotension, poor tissue perfusion, pulmonary edema, or oliguria
    is associated with what diagnosis?
    decreased cardiac output, possible large anterior MI
  14. How do panic attacks usually present?
    May have substernal chest pressure accompanied by fear of imminent death, choking sensations, shortness of breath, palpitations, sweating, lightheadedness, tremulousness, and/or nausea, paresthesias, fear of "going crazy", derealization (feelings of unreality), and depersonalization (feelings of being outside of or detached from oneself).
  15. Risk factor points for AMI:
    • 1 point for each:
    • 1. Age over 60 years
    • 2. Male sex
    • 3. Pain described as pressure
    • 4. Pain radiating to arm, shoulder, neck or jaw
  16. What EKG changes are seein in pericarditis?
    diffuse ST changes involving precordial and limb leads.
  17. How does pain in pericarditis present?
    worse when recumbant, releived by sitting forward.
  18. A patient with localized sharp or pleuritic chest pain likely has:
    Pain from a non-cardiac origin.
  19. A patient with a profound sense of unease accompanied by nausea and vomiting probably has what type of MI
  20. How do elderly patients with ACS often present
    with shortness of breath rather than chest pain.
  21. How do diabetics with ischemic cardiac pain present?
    They may have little or no pain
  22. Women with ischemic cardiac pain are more likely to report their pain where?
    In the neck, back or epigastrium.
  23. Findings on ECG in a person with ACS in order of importance
    • 1. ST segment elevation or depression of > 1mm in at least 2 consecutive leads.
    • 2. Q waves in at least 2 leads, not including aVr, not know to be old
    • 3. T-wave hyperacuity or inversion in at least 2 leads, not including aVr
    • 4. New bundle branch block.
  24. The 2 most common causes of chest pain in primary care in order:
    • 1 musculoskeletal
    • 2. Reflux
Card Set
Chest Pain (Continued)
Random facts from chapter 9, chest pain