Duke PA Chest Pain/Cardiac Emergency
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| Deep inspiration sharply worsens __ pain | Pleuritic chest pain
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| Inflammation of pleurae, usually caused by infection or connective tissue/inflammatory dz, friction rub with low grade fever | Pleurisy
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| Pleuritic chest pain, loud P2, right ventricular lift may indicated what | Pulmonary hypertension
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| Pleuritic pain with associated SOB, cough, fever, sputum production, rales and dullness may indicate what | Pneumonia
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| Dyspnea, chest tightness, wheezing and cough may indicate what | Asthma/COPD
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| Severe respiratory distress, frothy pink or white sputum, rales, S3/S4, PND, orthopnea, edema may indicate what | Pulmonary edema
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| 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
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| Innervation for the heart is similar to the innervation of what other organs | Esophagus, and stomach
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| Someone with a Mallory-Weiss tear will have what symptoms other than chest pain | Hematemesis with or without prior vomiting episode
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| Burning epigastric pain, post prandial sx, relieved with food, may have N/V, wt loss, anorexia and bleeding may indicate what | PUD
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| 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
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| Epigastric/RUQ visceral pain with fever/chills, N/V, anorexia may radiate to back or scapular region may indicate what | Cholecystitis
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| 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
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| Sharp pain, worse with movement/palpitation may be what | Musculoskeletal chest pain due to inflammation or irritation of chest wall structures
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| Rule out MI with serial __ | ECGs and cardiac biomarkers(CK/MB, troponin levels)
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| 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
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| Cardiac enzymes should be __ for stable angina | Negative
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| Treatment for stable angina pectoris | 81-325 ASA daily, beta blocker, ACE I, nitrates, statins
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| What does MOAN stand for in the treatment of unstable angina/NSTEMI | Morphine, O2, ASA, NTG
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| Ov ½ of deaths from acute STEMI occur within __ of event from V-fib | 1 hour
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| Physical signs of acute STEMI | HTN or hypotension, tachy/bradycardia, S3 or S4 or both, systolic murmurs, friction rub (day 2 or 3)
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| In acute STEMI early peaked T waves are seen __hrs after event | 0-6
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| In acute STEMI ST segment elevation is seen in __hrs after event | 0-18
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| In acute STEMI Q waves are seen in at least __hrs after the event | 18
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| Conditions causing chest pain and hypovolemia | MI, aortic dissection, leaking AAA
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| There is an increased risk of aortic dissection with __ | Bicuspid aortic valve or coarctation of the aorta
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| >95% of aortic dissections occur in the __ | Ascending aorta just distal to aortic valve or just distal to the left subclavian
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| What makes a Stanford A aortic dissection | Any involvement of ascending aorta
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| What makes a Stanford B aortic dissection | Not involving ascending aorta
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| 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
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| Evaluation of acute aortic dissection includes what | CXR, echo, CT, EKG
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| Useful for serial follow-up of aortic dissection | MRA/MRI
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| Appearance of aortic dissection on CXR | Widened aortic silhouette, widened mediastinum, left pleural effusion, 10-20% are normal
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| Medical treatment for acute aortic dissection | Beta blocker then nitroprusside to maintain SBP of 100-120 mmHg
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| Type __ aortic dissection gets surgical repair | A
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| Type __ aortic dissection gets medical treatment | B
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| 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)
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| 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
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| If suspected in hemodynamically stable pt, __ is 100% sensitive for AAA | Bedside ultrasound
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| 85% of __ is associated with viral etiology | Acute pericarditis
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| Excessive __ can cause hemorrhagic effusion leading to acute pericarditis | Anticoagulation
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| 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
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| Occurs when the pressure in the pericardial sac exceeds normal RV filling pressure, resulting in restricted filling and decreased cardiac output is | Cardiac tamponade
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| What is the most common etiology of cardiac tamponade | Malignancy
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| 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
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| hypotension, elevated systemic venous pressures (JVD), small quiet heart | Beck’s triad
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| what is Beck’s triad | Hypotension, elevated systemic venous pressure (JVD), small quiet heart
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| what is the treatment for cardiac tamponade | Massive volume resuscitation, pericardiocentesis, admit and consider pericardial window
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| severe elevation of BP, no evidence of progressive TOD, absence of raised intracranial pressure is what | Hypertensive urgency
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| short term treatment of hypertensive urgency | Labetalol, clonidine or captopril with outpatient follow up within 72 hrs is recommended
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| hypertensive emergency requires __ reduction of BP | Gradual (not to the normal range)
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| acute severe elevation in BP, evidence of rapidly progressive TOD is what | Hypertensive emergency
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| rapid correction of BP to normal levels in hypertensive emergency puts patient at risk for __ | Worsening cerebral, renal or cardiac ischemia
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| hypertensive urgency usually has a BP of >__ | 220/120
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| hypertensive emergency usually has a BP of > __ | 220/140
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