Differential Dx Of Chest Pain

Front 1

Should expect with chestpain in any postoperative, immobilized or bedridden patient.

Back 1

Pulmonary embolism

Front 2

Common causes of chest pain in older adults

Back 2

CAD
cervicodorsal arthritis
Tumors
Esophagitis
Pulmonary embolism

Front 3

Women with typical chest pain and no evidence of CAD are likely to have?

Back 3

Coronary Microvascular Disease

Front 4

Atypical symptoms that manifest cardiac ischemia.

Back 4

back pain
nausea
vomiting
dyspnea
severe fatigue

Front 5

5 characteristics of chest pain

Back 5

1. location
2. quality
3. duration
4. factors that precipitate or exacerbate pain
5. ameliorating factors

Front 6

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.

Back 6

Angina Pectoris

Front 7

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

Back 7

Pulmonary Hypertension

Front 8

Pain localized to the costochondral junction or specific intercostal spaces is most likely caused by?

Back 8

Costochondritis
Intercostal myositis

Front 9

Sticking, dull or pressing pain.
Chest wall tenderness on physical exam.

Back 9

Chest wall syndrome

Front 10

Pain that is substernal, at the left parasternal region near the shoulder and in the fourth and fifth intercostal space.

Back 10

Chest wall syndrome

Front 11

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.

Back 11

CAD and Reflux Esophagitis

Front 12

Pain during rest, lasting for a few minutes to several hours. Described as sticking, alleviated by lying down.

Back 12

Mitral Valve Prolapse

Front 13

Atypical chest pain is associated with arrhythmias (particulary tachyarrhythmias) and lightheadedness or syncope.

Back 13

Mitral Valve Prolapse

Front 14

Chest pain with fever, cough or hemoptysis. (2)

Back 14

pneumonia
pulmonary embolism

Front 15

Dyspnea (often precipitated by exercise) which usually precedes the development of chest pain.

Back 15

Hypertrophic Cardiomyopathy
(HCM)

Front 16

In any patient with angina pectoris who has coexisting or antecedent dyspnea--a careful search should be made for?

Back 16

Hypertrophic Cardiomyopathy
(HCM)

Front 17

What may be the only symptom associated with anginal pain in patients with effort-induced cardiac ischemia.

Back 17

Dyspne

Front 18

Chest pain that is not related to exertion but is r/t overeating and recumbancy. Pain typically awakens them at night.

Back 18

Chest pain caused by esophagitis

Front 19

Chest pain in patient with CHF, pain precipitated by minimal exertion, pain may awaken patient at night

Back 19

Angina Decubitus

Front 20

Sharp and piercing pain.
Pain with body movement
pain with coughing or sneezing
Pain after prolonged recumbancy.

Back 20

Cervicodorsal Arthritis

Front 21

Most frequent cause of noncardiac angina like chest pain is?

Back 21

Esophageal dysfunction

Front 22

Chest pain precipitated by physical exertion, emotional stress, sexual activity, exposure to cold, and occasionally eating.

Back 22

Angina Pectoris

Front 23

Type of angina occurring at rest.

Back 23

Prinzmetal's angina

Front 24

Chest pain due to pulmonary hypertension is also induced by?

Back 24

Exertion

Front 25

Chest pain from peptic esophagitis is often precipitated by ?

Back 25

Overeating
Recumbency

Front 26

Chest pain precipitated by swallowing cold liquids and things that stimulate the production of endogenous gatrin.

Back 26

Chest pain from eophageal spasm

Front 27

Chest pain that follows injestion of alcohol should suggest.

Back 27

Esophageal Spasm

Front 28

Chest pain during exercise such as jogging...but relieved by antacids?

Back 28

Esophageal Reflux

Front 29

Nirto exacerbates pain and intensifies the murmur in this condition

Back 29

Hypertrophic Cardiomyopathy

Front 30

Relived by nitro in 2-4 min.
Rest alone brings relief in less than 10 min

Back 30

Angina Pectoris

Front 31

Directions on proper use of Nitro.

Back 31

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.

Front 32

Valsalva Maneuver may give prompt relief from what type of chest pain ( decreases preload to the heart)

Back 32

Angina Pectoris

Front 33

occasionally, patients with HCM will obtain relief from chest pain by?

Back 33

Squatting
(decreases outflow obstruction)

Front 34

Tenderness in the region of spontaneous pain, especially if the quality of pain can be reproduced by pressure on the area suggests?

Back 34

Chest Wall Syndrome

Front 35

horizontal arm flexion and crowing rooster manuever cause pain with:

Back 35

Chest wall syndrome

Front 36

The most useful and noninvasive tests in the diagnosis of CAD

Back 36

Exercise ECG
Stress Echocardiogram

Front 37

2 ways to diagnose reflux esophagitis

Back 37

1. 14 day course of omeprazole 40 mg BID
2. 24 hr esophageal ph monitoring

Front 38

The ECG of MVP and CAD if present may include?

Back 38

1. ST segment depression
2.T wave inversion
3. abnormalities in leads II,III,and AVF.
4. Occasionaly in precordial leads

Front 39

The ST- segment / T wave changes of MVP may be differentiated from those of CAD by:?

Back 39

Oral administration of 40 mg of propranolol. May diminish or disappear 1 to 2 hours after. Patients with Angina pectoris are unaffected.

Front 40

The ECG is usually abnormal in patients with obstructive HCM. The most common ECG abnormalities include?

Back 40

Left ventricular hypertrophy
Intraventricular conduction defects
Nonspecific ST-Segment/T-wave changes
P-WAVE ABNORMALITIES
Transmural infarction-Q waves in anteroseptal or inferior leads

Front 41

This ECG finding is most helpful in the dx of HCM and not generally seen in pts with CAD.

Back 41

P- Wave Abnormalities suggestive of atrial enlargement

Front 42

Preferred study for dx of MVP and obstructive HCM

Back 42

Echocardiogram

Front 43

Preferred study to dx pulmonary embolism

Back 43

Helical CT

Front 44

Since women often have atypical symptoms of CAD- those with intermediate risk should be evaluated with noninvasive studies such as (2).

Back 44

1. Nuclear Scans
2. stress echocardiograms

Front 45

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.

Back 45

Cervical angina also called psedoangina.

Front 46

The dx of Cervical angina (psudoangina) is confirmed by?

Back 46

Finding cervical disc disease on MRI

Front 47

Usually localized to the costochondral junction. Constant or aggravated my movement of chest wall. incuding respiratory motion. pressure over painful area--replicates pain.

Back 47

Costochondritis
Costochondrodynia

Front 48

Relived by Beta Blockers and recumbency

Back 48

MVP

Front 49

The pain of a PE in the acute phase may be caused by?

Back 49

Plulmonary HTN
Subsequently pain is r/t pulmonary infarc with associated pleurisy.

Front 50

What should be suspected in patients with continual CP associated with diffuse ECG changes. CP aggrevated by change in position

Back 50

Pericarditis
A pericardial friction rub confirms the diagnosis

Front 51

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.

Back 51

Gas entrapment syndrome ( gas trapped in the hepatic or splenic flexure.)