S2: Ch1 Cv 1-4

Front 1

124. Acute pericarditis following MI? Tx?

Back 1

a. Tx consists of aspirin!!!!
b. NSAIDs and corticosteroids are contraindicated (may hinder myocardial scar formation).

Front 2

125. Dressler’s syndrome “Postmyocardial infarction syndrome”? and most effective therapy?

Back 2

a. Immunologically based syndrome consisting of fever, malaise, pericarditis, leukocytosis, and pleuritis, occurring weeks to months after an MI.
b. Aspirin is the most effective therapy.

Front 3

126. Differential dx of Chest pain?

Back 3

a. Heart, pericardium, vascular causes
b. Pulmonary
c. GI
d. Chest wall
e. Psychiatric
f. Cocaine use can cause angina or MI

Front 4

127. Heart, pericardium, vascular causes of chest pain?

Back 4

1. Stable angina, unstable angina, variant angina
2. MI
3. Pericarditis
4. Aortic dissection

Front 5

128. Pulmonary causes of chest pain?

Back 5

a. Pulmonary embolism (can have pain w/pulmonary infarction)
b. Pneumothorax
c. Pleuritis (pleural pain)
d. Pneumonia
e. Status asthmaticus

Front 6

129. GI causes of chest pain?

Back 6

a. GERD
b. Diffuse oesophageal spasm
c. Peptic ulcer disease
d. Oesophageal rupture

Front 7

130. Chest wall cause of chest pain?

Back 7

a. Costochondritis
b. Muscle strain
c. Rib fracture
d. Herpes zoster
e. Thoracic outlet syndrome

Front 8

131. Psych causes of chest pain (3)?

Back 8

a. Panic attacks
b. Anxiety
c. Somatization

Front 9

132. Approach to treating a pt w/chest pain? part 1

Back 9

1. Rule out any life-threatening causes.
a. These include acute MI, unstable angina, aortic dissection, pulmonary embolus, tension pneumothorax, and oesophageal rupture.
2. Assess vital signs
3. Develop a focused hx:
i. OLDCAARTS/setting in which it occurred.
ii. Does pt have a cardiac hx, ask about previous tests.
iii. If pt has a hx of angina, ask how this episode differs.

Front 10

132. Approach to treating a pt w/chest pain? part 2

Back 10

4. Perform focused physical exam, w/attention to C/V, abdominal, and musculoskeletal examination.
5. Order ancillary tests: enzymes, ecg, CXR, if appropriate- work up for pulmonary embolism PE.
6. Develop a diagnosis.

Front 11

133. It can be difficult to distinguish between GI causes of chest pain and angina- what is the decision of whether to initiate a cardiac workup based upon?

Back 11

a. The pt’s overall risk of CAD and clinical presentation.
b. If pt is young and w/out risk factors, tx for GERD and follow up if pain recurs. An older pt w/risk factors should undergo a cardiac workup

Front 12

134. Note: If you suspect a cardiac cause of chest pain, sublingual nitro is appropriate. Also give aspirin if pt does not have a bleeding disorder.

Back 12

a. If nitro relieves pain, a cardiac cause is more likely.

Front 13

135. Initial steps in pt w/stable angina who presents w/sx suggestive of USA?

Back 13

a. Obtain ECG and cardiac enzymes
b. Give aspirin
c. Begin IV heparin.

Front 14

136. General characteristics of CHF?

Back 14

a. CHF is a clinical syndrome resulting from the heart’s inability to meet the body’s circulatory demands under normal physiological conditions.

Front 15

137. Pathophys of CHF?

Back 15

a. ↓ Cardiac output -> Activation of renin-angiotensin-aldosterone system and activation of sympathetic nervous system.
b. These lead to Systemic vasoconstriction and volume retention.
c. -> ↑ Venous return, resulting in ↑ preload. This maintains CO.
d. However, if severe CHF, ↑ preload does not result in ↑ CO.
e. ↑ LVEDV causes ↑ LVEDP, which is transmitted back to pulmonary veins and leads to symptoms of pulmonary congestion.

Front 16

138. Frank-Starling Relationship?

Back 16

a. In a normal heart, increasing preload results in greater contractility.
b. When preload is low (at rest), there is little difference in performance between a normal and a failing heart. However, w/exertion, a failing heart produces relatively less contractility and symptoms occur.

Front 17

139. Systolic dysfunction in CHF?

Back 17

a. Owing to impaired contractility (i.e., the abnormality is decreased ejection fraction).
b. Causes include:
1. After a recent MI- most common cause of systolic dysfunction.
2. Cardiomyopathy
3. Myocarditis.

Front 18

140. Diastolic dysfunction in CHF?

Back 18

a. Owing to impaired ventricular filling during diastole (either impaired relaxation or increased stiffness of ventricle or both).
b. Echo shows impaired relaxation of left ventricle.

Front 19

141. 3 Causes of diastolic dysfunction?

Back 19

1. HTN leading to myocardial hypertrophy- most common cause of diastolic dysfunction.
2. Valvular diseases such as aortic stenosis, mitral stenosis, and aortic regurg.
3. Restrictive cardiomyopathy e.g., amyloidosis, sarcoidosis, hemochromatosis.