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Deep inspiration sharply worsens __ pain
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Inflammation of pleurae, usually caused by infection or connective tissue/inflammatory dz, friction rub with low grade fever
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DU PA Emer CP/Card
Duke PA Chest Pain/Cardiac Emergency
| Question | Answer |
|---|---|
| Deep inspiration sharply worsens __ pain | Pleuritic chest pain |
| Inflammation of pleurae, usually caused by infection or connective tissue/inflammatory dz, friction rub with low grade fever | Pleurisy |
| Pleuritic chest pain, loud P2, right ventricular lift may indicated what | Pulmonary hypertension |
| Pleuritic pain with associated SOB, cough, fever, sputum production, rales and dullness may indicate what | Pneumonia |
| Dyspnea, chest tightness, wheezing and cough may indicate what | Asthma/COPD |
| Severe respiratory distress, frothy pink or white sputum, rales, S3/S4, PND, orthopnea, edema may indicate what | Pulmonary edema |
| Chest pain may be squeezing or pressure like (substerna/epigastric), exertional or at rest, diaphoresis, radiation, N/V, post-prandial, postural changes, spasm and may be relieved with antacids/NTG may indicate what | Heartburn/GERD |
| Innervation for the heart is similar to the innervation of what other organs | Esophagus, and stomach |
| Someone with a Mallory-Weiss tear will have what symptoms other than chest pain | Hematemesis with or without prior vomiting episode |
| Burning epigastric pain, post prandial sx, relieved with food, may have N/V, wt loss, anorexia and bleeding may indicate what | PUD |
| Acute, severe, unrelenting and diffuse pain in chest, neck or abdomen. May radiate to back or shoulders and swallowing may exacerbate pain may indicate what | Esophageal perforation |
| Epigastric/RUQ visceral pain with fever/chills, N/V, anorexia may radiate to back or scapular region may indicate what | Cholecystitis |
| Midepigastric, piercing pain, constant, radiates to back, associated with N/V, abdominal distention, low grade fever, tachycardia and hypotension may be present with what | Pancreatitis |
| Sharp pain, worse with movement/palpitation may be what | Musculoskeletal chest pain due to inflammation or irritation of chest wall structures |
| Rule out MI with serial __ | ECGs and cardiac biomarkers(CK/MB, troponin levels) |
| Deep, pressure-like pain in substernal region, may radiate to jaw, neck or left shoulder/arm. Frequently associated with SOB, transient, precipitated by physical exertion or stress, responsive to rest or SL NTG may be what | Stable angina pectoris |
| Cardiac enzymes should be __ for stable angina | Negative |
| Treatment for stable angina pectoris | 81-325 ASA daily, beta blocker, ACE I, nitrates, statins |
| What does MOAN stand for in the treatment of unstable angina/NSTEMI | Morphine, O2, ASA, NTG |
| Ov ½ of deaths from acute STEMI occur within __ of event from V-fib | 1 hour |
| Physical signs of acute STEMI | HTN or hypotension, tachy/bradycardia, S3 or S4 or both, systolic murmurs, friction rub (day 2 or 3) |
| In acute STEMI early peaked T waves are seen __hrs after event | 0-6 |
| In acute STEMI ST segment elevation is seen in __hrs after event | 0-18 |
| In acute STEMI Q waves are seen in at least __hrs after the event | 18 |
| Conditions causing chest pain and hypovolemia | MI, aortic dissection, leaking AAA |
| There is an increased risk of aortic dissection with __ | Bicuspid aortic valve or coarctation of the aorta |
| >95% of aortic dissections occur in the __ | Ascending aorta just distal to aortic valve or just distal to the left subclavian |
| What makes a Stanford A aortic dissection | Any involvement of ascending aorta |
| What makes a Stanford B aortic dissection | Not involving ascending aorta |
| Sudden onset retrosternal and back pain, may see infarct pattern on ecg, neurologic deficits/CVA, limb ischemia, syncope, shock, hypertensive, pulse discrepancies, tamponade possible may indicate | Aortic dissection |
| Evaluation of acute aortic dissection includes what | CXR, echo, CT, EKG |
| Useful for serial follow-up of aortic dissection | MRA/MRI |
| Appearance of aortic dissection on CXR | Widened aortic silhouette, widened mediastinum, left pleural effusion, 10-20% are normal |
| Medical treatment for acute aortic dissection | Beta blocker then nitroprusside to maintain SBP of 100-120 mmHg |
| Type __ aortic dissection gets surgical repair | A |
| Type __ aortic dissection gets medical treatment | B |
| What exceptions would cause a type B aortic dissection to qualify for surgery | Rupture, limb or visceral ischemia, ongoing pain, saccular morphology, uncontrolled HTN, Marfan’s or AI (rare) |
| Pain if present, described as epigastric fullness or lower back and hypogastric region, gnawing, hours to days in duration, not positional may be what | AAA |
| If suspected in hemodynamically stable pt, __ is 100% sensitive for AAA | Bedside ultrasound |
| 85% of __ is associated with viral etiology | Acute pericarditis |
| Excessive __ can cause hemorrhagic effusion leading to acute pericarditis | Anticoagulation |
| Pleuritic, sharp, stabbing chest pain that radiates to shoulders, back, neck that is worse on deep inspiration or movement, worse supine and relieved by sitting up and leaning forward may be what | Acute pericarditis |
| Occurs when the pressure in the pericardial sac exceeds normal RV filling pressure, resulting in restricted filling and decreased cardiac output is | Cardiac tamponade |
| What is the most common etiology of cardiac tamponade | Malignancy |
| beat to beat variability in the amplitude of the P & R waves unrelated to inspiratory cycle…really only see ~ 20% of time, but is diagnostic of cardiac tamponade if present | Electrical alternans |
| hypotension, elevated systemic venous pressures (JVD), small quiet heart | Beck’s triad |
| what is Beck’s triad | Hypotension, elevated systemic venous pressure (JVD), small quiet heart |
| what is the treatment for cardiac tamponade | Massive volume resuscitation, pericardiocentesis, admit and consider pericardial window |
| severe elevation of BP, no evidence of progressive TOD, absence of raised intracranial pressure is what | Hypertensive urgency |
| short term treatment of hypertensive urgency | Labetalol, clonidine or captopril with outpatient follow up within 72 hrs is recommended |
| hypertensive emergency requires __ reduction of BP | Gradual (not to the normal range) |
| acute severe elevation in BP, evidence of rapidly progressive TOD is what | Hypertensive emergency |
| rapid correction of BP to normal levels in hypertensive emergency puts patient at risk for __ | Worsening cerebral, renal or cardiac ischemia |
| hypertensive urgency usually has a BP of >__ | 220/120 |
| hypertensive emergency usually has a BP of > __ | 220/140 |
Created by:
bwyche
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