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146 Cards in this Set
- Front
- Back
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Typical chest pain is not seen in what poopulation |
elderly women heart transplant diabetic |
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What is chronic chest pain |
Pain over six months |
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What is somatic pain |
Soft tissue pain |
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What are qualities of somatic pain |
Well localized not radiating |
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Given example of somatic pain |
Running twisting your ankle |
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What are the qualities of the visceral pain |
Hard to pinpoint dullaching poorly localize radiates often |
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What disorders will have neuropathic pain |
Shingles herpes |
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describe neuropathic pain quality |
Shooting electric |
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Most common cause of noncardiac chest pain |
GER D |
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Bodily or emotional type of sensation |
Terrifying nauseating sickening |
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Penetrating tissue destruction type of sensation |
Stabbing burning twisting tearing squeezing |
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Life-threatening causes of chest pain |
And acute coronary syndrome pulmonary embolism aortic dissection pericarditis pneumothorax issac and she'll rupture |
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Low-risk patients less than 50 years old most common cause of chest pain |
Gastritis |
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When assessing for chest pain what do you ask for |
OPQRST onset provocation palliation Quality RAdiation site tiMING and associated symptoms prior work up |
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Epigastric pain that radiates to the shoulder and overweight |
Gallstones |
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When asking about prior work up what should you ask |
Prior diagnostics is the discomfort SIMILAR associated symptoms risk factors comorbidities recent events and other factors like cocaine cigarette and family history |
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Of these disorders have a sudden and severe pain at onset |
Aortic dissection pneumothorax pulmonary embolism |
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Qualities of aortic dissection pain |
Ripping tearing nice in lower back |
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Pneumothorax type pain Quality |
Ipsilateral same side with a problem very localized sharkPand pleuritic may become dull and achy overtime |
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Pain starts suddenly and worsened over time |
Pulmonary embolism |
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Pulmonary embolism quality of pain |
Starts suddenly worsened over time worsened with deep inspiration localized to chest wall |
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Pain that starts suddenly at rest |
Nontraumatic pneumothorax |
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True or false patients with a PE 95% of the time will have tACYPNEA |
True |
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History of forceful vomiting preceding symptoms |
Ruptured esophagus |
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Gradually and worsens with exertion |
Acute coronary syndrome |
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Gets better when you lean forward and worsens when you lean back |
Pericarditis |
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Reproduced by movement or palpation of Chestwall |
Musculoskeletal |
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Acute coronary syndrome pain is described as what |
Discomfort pressure happiness tightness fullness |
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True or false patient with acute COROnary syndrome ischemia is less likely if the state the pain feels like A sharp knife pleuritic or positional |
True |
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Associated symptoms with acute coronary syndrome |
Diaphoresis nausea vomiting |
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Elderly patient with acute coronary syndrome may complain of what |
Weakness altered mental status syncope |
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Cough syncope hemoptysis can be seen in which disorders |
Pulmonary embolism valvular heart disease |
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These diagnostic test should be done for chest pain |
EKG within 10 minutes cardiac markers chest x-ray D dimer CBC cam seven BNP |
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CBC on a patient with chest pain tells you what |
About infectious process payment can be cause by pneumonia or upper G.I. It can also show you anemia which can CAUSE low profusion and chest pain especially with increased activity leukemias and lYMPHOMAS |
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Why do people with and myocardial infarction have elevated white blood cell count |
Because it is an inflammatory process sensitivity but not specific |
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When doing a CHEM7 don't forget to include what |
Magnesium level |
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Orders for chest pain |
Oxygen nitroglycerin 0.4 three times five minutes apart or start a trip at 5 to 10 Mike's per minute aspirin 81 Times foUR if they did not take any plaVICS if allergic to aspirin cardiac monitor. Pulse oximetry morphine if chest pain continues after Nitro |
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What is the downfall of giving nitroglycerin for chest pain |
People with esophageal spasm Will also get better so he cannot rule out cardiac |
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Diagnostic test for chest pain |
CT TEE VQ scan coronary CT nuclear imaging bedside ultrasound |
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What are we looking for any coronary CT |
Calcium deposition |
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This is an invasive diagnostic tests for chest pain |
Cardiac caTH |
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Noninvasive testing for chest pain |
Blood carotid and extremity vascular testing CT echo EKG hoeltzer and event loop monitoring stress test MRI nuclear cardiology testVO2 MAX |
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What is VO2 MAX STUDY |
For patients who are about to exercise to see if they can tolerate it checks for maximal oxygen uptake reflects physical fitness |
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List of blood tests done in a cardiac workup |
Antistreptolysin O ABG lipid profile blood calcium BNP C reactive proteins carbon dioxide CBC electrolytes ESR cardiac enzymes glucose PTI INR myoglobin waste products |
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What is C reactive protein |
Anti-inflammatory marker it provides information on patients at risk of having a heart attack or show high levels indicate there is information somewhere |
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Normal level of C reactive protein |
Less than 0.1 mg per deciliter or less then 1 mg/L puts you at Lovis |
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Average RISK for C-reactive protein |
0.1- 0.3 OR 1-3 |
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C-reactive protein higher risk |
Greater than 0.3 or greater than three |
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What does ESR check for |
Rate at which the red blood cells separate from plasma |
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High levels of ESR can occur in what disorders |
Rheumatic fever and severe anemia cancer relapse |
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Low levels of ESR can occur in what what disorder |
Heart failure sickle cell anemia |
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Normal ESR |
Men under 50 should be less than 15 men over 50 should be less than 20 Women under 50 less than 20 Women over 50 less than 30 |
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Antistreptolysin O tests for what |
Tests for group a strep it tells you about endocarditis it is a pro team made by strep bacteria in response to infection the body makes streptolysin antibodies called streptolysin oh |
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New onset of murmur with fever |
Endocarditis |
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What will you see on your physical exam for endocarditis |
Splinter hemorrhage roTH spots osler noDES janeway lesions petechiae |
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What a rotH spots |
Retinal hemorrhage with small clear Center RARE FINDINF |
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Worker splinter hemorrhage |
Dark red lINEAR lesions on nailbeds |
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What are OSLER NODES |
Tender subcutaneous nodules on distal digits |
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What are Janeway lesions |
Nontender macula on palms and soles |
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Normal antistreptolysin O |
Less then 200 |
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What is important to take into consideration when doing a lipid profile |
The ratio is more import than the individual number |
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Normal cholesterol |
Less than 200 |
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Normal HDL |
Greater than 40 in women greater than 60 |
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Normal LDL |
Less than 70 |
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Normal triglycerides |
Less 150 |
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What other disorders will have an elevated BNP |
Severe pneumonia COPD |
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Normal BNP |
Less than 100 |
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Cardiac enzymes |
CKMB CPK LDH troponin myoglobin |
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Qualities of myoglobin |
Rises early and disappears early rises an hour after something cheeks in four hours normalizes in 24 to 36 hours |
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What is myoglobin |
Oxygen binding proteins found in cardiac and skeletal muscles |
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Cardiac marker that has the longest duration |
Troponin up to 10 days |
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Difference between troponin and CK/CKMB |
CK/MB only lasts for about 48 hours troponin last longer |
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What is CK MB considered positive |
CKMB must be 3 to 7% of total CK even if CKMB it's abnormal it is only significant if it is 3 to 7% |
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When will there be an elevated myoglobin |
RHABDO muscle trauma large trauma |
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What is the downfall of myoglobin test |
Is very sensitive but not specific it will be elevated even with shivering someone with myocardial infarction Will have blood in urine but it is not really bloody since there are no RBCs |
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Most sensitive and specific cardiac enzymes |
Troponin |
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Waste products that measure waiste in blood include what |
b UN creatinine and uric acid |
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Abnormal waste products can be cause by what |
Hartfell your heart attack or kidney disease |
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Patients with renal failure having chest pain can be due to what |
Hyperkalemia or peicardial effusion |
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A bad pericardial effusion can turn into what |
tamponade |
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When will you suspect a tapenade |
Becks triad |
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What is Becks triad |
Jugular vein distention distant heart sounds and hypotension |
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What tissues will have LDH |
Hearts liver kidney skeletal muscle bring red blood cells and lungs |
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This cardiac enzymes takes the longest to elevate |
LDH |
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Is cardiac enzymestays elevated the lonest |
Troponin T and LDH |
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Where does atherosclerosis begin and travel |
It begins in the abdominal aorta and it acsends to involve aortic arch and coronary arteries as well as carotid arteries |
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This is a clinical test use for peripheral artery disease |
Carotid ultrasound looking for triple a |
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This is used to assess risk in arterial disease |
ABI |
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ABI 0-0.4 |
Severe peripheral artery disease sufficient to cause breast pain or gangrene |
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ABI 0.4 to 0.9 |
Good circulation unless there is increased demand is manifested by claudication or angina |
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Normal ABI |
0.9 -1.3 |
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ABI greater than 1.3 |
Severely calcified vessel |
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What is a CT scan |
Cross-section of internal organs multiple x-rays from different angles to create a three dimensional Image |
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These are types ofct scans |
Helical cat and multi-sliced cat |
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helical cat |
Special slip ring technology to create a continuously moving x-ray |
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Multislice cat |
Creates up to 64 images and allows you A close and intricateheartstructures |
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Best definitive test for AAA |
CT |
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Good initial testing for AAA |
Echo |
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What is a CTA |
3-D view of moving heart and great pestles detects fatty or calcium and Arteries |
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What is an echo |
Use soundwaves to create still moving pictures of heart chambers and valves |
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What are types of echoes |
Color flow Doppler echo Signal averaged ECG stress echo TEE |
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Is TEE a good initial test |
No |
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Why do we do an echo for a stroke patient |
To look for septal defects |
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What is the purpose of a doppler in Echo |
Used to determine bloodflow velocity determines cardiac chambers low pressures in the right |
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What is the purpose of color flow Doppler |
Developed to noninvasively determine blood flow |
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When is an echo indicated |
Arrhythmia cardioversion endocarditis myocardial infarction to look for decreased compliance coronary artery disease chest pain stroke embolism pulmonary disease hypertension heart murmur pericarditis shock syncope |
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What will c impair a transthoracic echo |
Body size and Chestwall not for obese emphysemalarge breast |
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Who is not a good candidate for transthoracic echo |
Obese emphysema large breasts |
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What does a transthoracic echo do |
Quantitative measurements of cardiac dimensions chamber size left ventricular Wall thickness area and volume |
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What does it Doppler echo show |
Chamber size the thickness of walls early closure of mitral valve LV mass tumor or clot anatomic valvular pathology septal defects pericardial effusion ejection fraction severity of valve stenosis severity of valve regurgitation RV PA pressures stroke volume and cardiac output LV diastolic dysfunction disease of the aorta |
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EKG done while pacing is exercising |
Exercise tolerance test |
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When is an exercise tolerance test indicated |
Coronary artery disease exercise capacitance of heart failure patients to help diagnose heart related causes of symptoms like chest pain shortness of breath or lightheadedness predictive risk of heart Failure angina shortness of breath on exception six weeks post myocardial infarction asymptomatic healthy person at high risk Women over 50 men over 40 two or more risk factors valvular disease |
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Contraindication to a stress test |
Acute MI unstable angina acute cardiac information like pericarditis and endocarditis severe congestive heart failure uncontrolled ventricular arrhythmias high-grade heart block hemodynamically significant aortic stenosis severe hypertension systolic over 200 or diastolic over 100 active thromboembolism Extreme obesity over 350 pounds severe mental or physical disability |
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When is an MRI used in cardiology |
Aorticr disease blockagecoronary artery cardiomyopathy heart valve disease disease and arteries outside of the heart work for referral artery disease congenital heart defects to detect atrial Myxoma |
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Two types of nuclear cardiology test |
Myocardial perfusion test and pharmacology stress test |
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These are invasive tests |
Cardiac cath cardiac biopsy EPS |
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Wendo we refer to EPS |
Heart rhythm disorder patient at risk for sudden cardiac death for example Brugada syndrome evaluate the effectiveness of medication predict the risk of a future cardiac event assess the need for it in plantable device for treatment procedure |
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When is a cardiac calf indicated |
Stable angina with an abnormal stress test unstable angina abnormal perfusion test return angina Post intervention stemi NST EMI preop evaluation |
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Goals of cardiac calf |
Confirmed the presence of a suspected heart disease quantified the severity of the disease and its effect on the heart seek out the caused symptoms like shortness of breath chest pain and fatigue |
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Risk for cardiac calf |
Minor bleeding at the site temporary heart rhythm disturbance temporary changes in blood pressure cardiac tamponade sudden blockage of coronary arteries pseudoaneurysm stroke |
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Treatment options after a cardiac catheter |
Percutaneous coronary intervention medical management bypass do nothing if it's clear angioplasty |
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Benefits of percutaneous coronary intervention |
Can include removal of the actual artery less invasive shorter hospital stay quicker recuperation lower-cost |
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What is metabolic syndrome |
Increased BMI and female greater than 35 in mail greater than 40 increased cholesterol hypertension increased waist circumference |
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First choice cholesterol-lowering agents in stable angina |
Statins |
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When is PCI or bypass indicated |
Angina refractivity to medical treatment angina and reduce LV function sephia activity limiting angina angina in the presence of left main or severe three vessel CAd |
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What is important to order with statins |
LFTs |
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Caution with statins |
Can be hepatotoxic increases rhabdo with macrolides antifungal calcium channel blockers |
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Causes of cardiac Tampanod |
Idiopathic pericarditis infection Post cardiotomy trauma radiation heart attack |
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treatment of tamponade |
Maintain adequate filling pressures with fluids avoid diuertics nitrates and other drugs that be reduces preload avoid effort to slow sinus tachycardia pericardiocentesis immediately before sedatives given surgical treatment pericardiocentesis |
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Gold standard of Stemi |
pci if not TPA or transfer to PCI |
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What is reperfusion injury |
Oxygen gives us free radicals which is harmful to cells after you fix the occlusion this can happen there is a sudden rush of oxygen to tissues that creates free radicals this leads to arrhythmias that is why we use beta blockers because it is cardioprotective |
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First-line drugs for heart Failure |
ace followed by a beta blocker |
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Most common cause of heart failure |
left - htn, right is left sided hf |
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Will there be EKG and xtray changes in stage a heart fellion |
No they only have risk factors |
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Stage b heart failure will show what |
EKG changes cardiomegaly but no overt symptoms of neck swelling or shortness of breath |
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What is the treatments for stage be heart failure |
Ace inhibitor |
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Qualities of beta blockers |
Negative inotrope negative chronotropic negative drama trope |
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What is the caution forgiving beta blockers in heart failure |
It can worsen you this is for stable chronic patients not for a cute patient |
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When do we add a diuretic to heart failure treatment |
When the patient is symptomatic |
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Qualities of digoxin |
Positive inotrope negative chronotropic |
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When will you consider putting a patient onto Jdigoxin therapy |
With an ejection fraction less than 40 it will improve symptoms but doesn't decrease mortality |
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Early signs of dig toxicity |
Nausea abdominal pain anorexia |
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Late signs of ditch toxicity |
Abnormalities around lighting Brady or tachyarrhythmias |
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To make it beta blockers in Tampanod |
no they need their sympathetic response |
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Herpes zoster can lead to what |
Pleural effusion |
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Main contraindication for aspirin therapy |
Allergic reaction not bleeding if they have a bleeding ulcer you can give them rectal aspirin |
