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DU PA Emer CP/Card

Duke PA Chest Pain/Cardiac Emergency

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