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51 Cards in this Set
- Front
- Back
Should expect with chestpain in any postoperative, immobilized or bedridden patient.
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Pulmonary embolism
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Common causes of chest pain in older adults
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CAD
cervicodorsal arthritis Tumors Esophagitis Pulmonary embolism |
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Women with typical chest pain and no evidence of CAD are likely to have?
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Coronary Microvascular Disease
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Atypical symptoms that manifest cardiac ischemia.
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back pain
nausea vomiting dyspnea severe fatigue |
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5 characteristics of chest pain
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1. location
2. quality 3. duration 4. factors that precipitate or exacerbate pain 5. ameliorating factors |
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Characteristics
Pain is paroxysmal (lasting 30 sec to a few min). Pain is dull, prssing, squeezing or aching. Located substernally May radiate to the precordium, upper extremities, neck or jaw. |
Angina Pectoris
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Pain is dull, pressing, substernal pain. Precipitated by exertion and relieved by rest or administration of nitroglycerin. may radiate to either arm. More often to Right arm
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Pulmonary Hypertension
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Pain localized to the costochondral junction or specific intercostal spaces is most likely caused by?
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Costochondritis
Intercostal myositis |
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Sticking, dull or pressing pain.
Chest wall tenderness on physical exam. |
Chest wall syndrome
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Pain that is substernal, at the left parasternal region near the shoulder and in the fourth and fifth intercostal space.
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Chest wall syndrome
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Dull substernal pain incuced by exercise and relieved by nitroglycerin and dull sub sternal pain radiating to the neck and arms not relieved by nitro but by antacid.
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CAD and Reflux Esophagitis
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Pain during rest, lasting for a few minutes to several hours. Described as sticking, alleviated by lying down.
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Mitral Valve Prolapse
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Atypical chest pain is associated with arrhythmias (particulary tachyarrhythmias) and lightheadedness or syncope.
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Mitral Valve Prolapse
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Chest pain with fever, cough or hemoptysis. (2)
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pneumonia
pulmonary embolism |
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Dyspnea (often precipitated by exercise) which usually precedes the development of chest pain.
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Hypertrophic Cardiomyopathy
(HCM) |
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In any patient with angina pectoris who has coexisting or antecedent dyspnea--a careful search should be made for?
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Hypertrophic Cardiomyopathy
(HCM) |
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What may be the only symptom associated with anginal pain in patients with effort-induced cardiac ischemia.
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Dyspne
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Chest pain that is not related to exertion but is r/t overeating and recumbancy. Pain typically awakens them at night.
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Chest pain caused by esophagitis
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Chest pain in patient with CHF, pain precipitated by minimal exertion, pain may awaken patient at night
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Angina Decubitus
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Sharp and piercing pain.
Pain with body movement pain with coughing or sneezing Pain after prolonged recumbancy. |
Cervicodorsal Arthritis
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Most frequent cause of noncardiac angina like chest pain is?
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Esophageal dysfunction
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Chest pain precipitated by physical exertion, emotional stress, sexual activity, exposure to cold, and occasionally eating.
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Angina Pectoris
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Type of angina occurring at rest.
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Prinzmetal's angina
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Chest pain due to pulmonary hypertension is also induced by?
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Exertion
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Chest pain from peptic esophagitis is often precipitated by ?
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Overeating
Recumbency |
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Chest pain precipitated by swallowing cold liquids and things that stimulate the production of endogenous gatrin.
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Chest pain from eophageal spasm
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Chest pain that follows injestion of alcohol should suggest.
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Esophageal Spasm
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Chest pain during exercise such as jogging...but relieved by antacids?
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Esophageal Reflux
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Nirto exacerbates pain and intensifies the murmur in this condition
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Hypertrophic Cardiomyopathy
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Relived by nitro in 2-4 min.
Rest alone brings relief in less than 10 min |
Angina Pectoris
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Directions on proper use of Nitro.
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1. let nitro dissolve under tongue ( do not swallow)
2. expect a warm flushing feeling 3. Keep saliva under the tongue until pain is relieved. At this point pt may swallow or spit out. |
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Valsalva Maneuver may give prompt relief from what type of chest pain ( decreases preload to the heart)
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Angina Pectoris
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occasionally, patients with HCM will obtain relief from chest pain by?
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Squatting
(decreases outflow obstruction) |
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Tenderness in the region of spontaneous pain, especially if the quality of pain can be reproduced by pressure on the area suggests?
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Chest Wall Syndrome
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horizontal arm flexion and crowing rooster manuever cause pain with:
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Chest wall syndrome
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The most useful and noninvasive tests in the diagnosis of CAD
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Exercise ECG
Stress Echocardiogram |
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2 ways to diagnose reflux esophagitis
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1. 14 day course of omeprazole 40 mg BID
2. 24 hr esophageal ph monitoring |
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The ECG of MVP and CAD if present may include?
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1. ST segment depression
2.T wave inversion 3. abnormalities in leads II,III,and AVF. 4. Occasionaly in precordial leads |
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The ST- segment / T wave changes of MVP may be differentiated from those of CAD by:?
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Oral administration of 40 mg of propranolol. May diminish or disappear 1 to 2 hours after. Patients with Angina pectoris are unaffected.
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The ECG is usually abnormal in patients with obstructive HCM. The most common ECG abnormalities include?
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Left ventricular hypertrophy
Intraventricular conduction defects Nonspecific ST-Segment/T-wave changes P-WAVE ABNORMALITIES Transmural infarction-Q waves in anteroseptal or inferior leads |
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This ECG finding is most helpful in the dx of HCM and not generally seen in pts with CAD.
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P- Wave Abnormalities suggestive of atrial enlargement
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Preferred study for dx of MVP and obstructive HCM
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Echocardiogram
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Preferred study to dx pulmonary embolism
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Helical CT
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Since women often have atypical symptoms of CAD- those with intermediate risk should be evaluated with noninvasive studies such as (2).
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1. Nuclear Scans
2. stress echocardiograms |
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Rare cause of CP similar to Angina pectoris. Pain not brought on by exertion. but precipitated by cervical motion-sneezing, coughing, aggravated by tilting heal laterally.
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Cervical angina also called psedoangina.
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The dx of Cervical angina (psudoangina) is confirmed by?
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Finding cervical disc disease on MRI
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Usually localized to the costochondral junction. Constant or aggravated my movement of chest wall. incuding respiratory motion. pressure over painful area--replicates pain.
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Costochondritis
Costochondrodynia |
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Relived by Beta Blockers and recumbency
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MVP
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The pain of a PE in the acute phase may be caused by?
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Plulmonary HTN
Subsequently pain is r/t pulmonary infarc with associated pleurisy. |
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What should be suspected in patients with continual CP associated with diffuse ECG changes. CP aggrevated by change in position
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Pericarditis
A pericardial friction rub confirms the diagnosis |
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Hx of CP when pt bends over or wears a tight garment. exacerbated by bending, flexing the thigh on chest, palpating colon. Relieved by fatulence or sublingual nitro.
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Gas entrapment syndrome ( gas trapped in the hepatic or splenic flexure.)
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