Symptoms
Common symptoms can occur as a result of: list 4 diagnoses.
Cardiovasular, Pulmonary, Musculoskeletal, GI, Herpes Zoster, or Anxiety
Describe typical symptoms of MI
Dull, aching, sensation of pressure, tightness, squeezing that usually will subside in 5-20, but may last longer
Most important part of physical exam with chest pain?
Vital signs with pulse ox
Most commonly ordered diagnostic test with chest pain?
EKG
Pain is greater supine than upright.
A cardiac friction rub is present - best heard with patient leaning forward at end expiration.
Pericarditis
Life threatening causes of chest pain: list 4
ACS, pericarditis, aortic dissection, vasospastic angina, PE, pneumonia and esophageal perforation
Symptoms at rest may represent
Unstable Angina
Pain that is palpable and reproducible is likely what?
Muskuloskeletal
Strongest predictor on EKG of acute MI?
ST elevation
Cardiac Tamponade with pericarditis is determined by?
Assessing for pulsus paradoxus - a decrease in systolic BP during inspiration greater than 10mmHG and Inspection of JV pulsation.
Conditions that have a high risk for CAD: list 3
Lupus, RA, Reduced GFR, and HIV
The location of pain with acute MI is usually either:
Retrosternal or left precordial
Physical findings that increase likelihood of acute coronary syndrom? List 3
Diaphoresis, hypotension, s3 or s4 gallop, pulmonary crackles, or elevated jugular venous pressure.
Chest x-ray reveals what added information?
Hypertrophy of ventricles, aortic stenosis
Pneumonia, PE
This is usually very abrupt onset of a tearing pain of great intensity that radiates to the back.
Aortic dissection
Risk Factors for VTE: list 5
Cancer, trauma, recent surgery, prolonged immobilization, pregnancy, oral contraceptives, family history, personal history of prior VTE.
Approximately how many patients experience an acute MI without chest pain?
Where is the pain commonly referred?
1/3
referred pain to throat, lower jaw, shoulders, arms, upper abdomen or back.
Ischemic pain may be precipitated or exacerbated by: list 3
exertion, cold temperatures, meals, stress, or a combination of these.
List other common cardiac test
Stress test - monitors your heart electrical rhythyms and chest pain as related to exertion
MRI - to view interior soft tissues of heart
CTA -coronary computed tomography angiogram uses advanced CT technology, along with intravenous (IV) contrast material (dye), to obtain high-resolution, 3D pictures of the movingheart and great vessels "triple rule out" - CAD, ACS, PE.
Clinical findings and risk factors most suggestive of Acute coronary syndrome are?
Previous abnormal stress test, peripheral artery disease, pain radiation to both arms.
Patients with this syndrome often present with acute chest syndrome with chest pain, fever and cough.
Sickle cell anemia
Explain why patients may not have pain, or experience referred pain.
The heart lacks somatic innervation as an autonomic system. It lacks sensory and efferent (motor) nerves. So there can be no pain and a wide range of referred pain.
Elderly women and persons with DM may present with atypical signs and symptoms? List 4
Shortness of Breath, Dizziness, feelings of impending doom, vagal symptoms such as nausea and diaphoresis, and fatigue.
Common labs specific to Acute MI and what information does it provide?
D-dimer to rule out VTE
High sensitivity cardiac troponin to determine damage to cardiac muscle.
Term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. One condition under the umbrella of acute coronary syndromeis myocardial infarction (heart attack) — when cell death results in damaged or destroyed heart tissue.
Acute Cornonary Syndrom.