Evaluation of Chest Pain
Chest pain associated with exercise has a likelihood ratio of 4.7 of being associated with this diagnosis
What is acute coronary syndrome (ACS)?
These are 4 possible characteristics of a panic attack
What are: palpitations, sweating, trembling, sensations of dyspnea or choking, chest pain/discomfort, nausea, dizziness, chills/heat, parasthesias, derealization, fear of losing control, fear of dying?
4 or more of these symptoms must be present for a diagnosis of panic attack
These abnormalities suggest atrial fibrillation
What are P wave abnormalities, supraventricular premature beats, and bradycardia?
These are the 3 demographic categories currently used in the ASCVD risk estimator
What are age, gender, and race?
This is one of the first line treatments for hypertension control in a patient with diabetes without nephropathy
What is an ACE-I/ARB or CCB or thiazide diuretic?
This is a tool to understand the patient's diet to make informed recommendations for cardiovascular health
What is a 24 hour diet recall/diet diary?
These are 3 possible systemic causes of palpitations
What are hyperthyroidism, hypoglycemia, postmenopausal syndrome, fever, anemia, pregnancy, hypovolemia, orthostatic hypotension, postural orthostatic tachycardia syndrome, pheochromocytoma, arteriovenous fistula?
This abnormality suggests prior myocardial infarction
What are Q waves?
These are 3 of the components of Wells Criteria for diagnosing pulmonary embolism
Clinical signs and symptoms of deep vein thrombosis (DVT) 3 points
PE is the most likely diagnosis 3 points
Heart rate > 100 1.5 points
Immobilization at least 3 days, or surgery in the previous four weeks 1.5 points
Previous, objectively diagnosed PE or DVT 1.5 points
Hemoptysis 1 point
Malignancy or treatment within six month, or palliative 1 point
This intensity level of statin is indicated in a patient 40-75 yo with diabetes and a ASCVD risk > 7.5%
What is a high intensity statin?
A moderate intensity statin is used if ASCVD risk ≤ 7.5%
These are the 3 P's of chest pain quality that reduce the likelihood of ACS
What are: Pleuritic, Positional, reproduced by Palpation?
Also stabbing Pain
These are 4 of the main categories of causes of palpitations
What are: cardiac arrhythmias, structural heart disease, psychiatric disorders, systemic causes, and medication effects?
What are prolongation of the QT interval and abnormal T waves?
These are three of the measurements used in the ASCVD risk calculator
What are blood pressure, total cholesterol, HDL, and LDL?
This is the first line medication for the treatment of hypertension in a patient with chronic kidney disease
What is an ACE-I/ARB? (Cannot use both)
A CCB or thiazide may be used as add on therapy to reach a goal of 130/80 mmHg
These are 4 of the typical characteristics of a history of angina, using the OPQRST mnemonic
What are:
Onset: sudden
Provocation/palliation: may be exercise, cold, emotional stress, meals, sexual intercourse
Quality: squeezing, tightness, pressure
Radiation/region: substernal, radiating to the upper extremity/shoulder/neck/throat/lower jaw/teeth (if wide extent, think MI!!!)
Severity: typical is severe, atypical angina is not felt as severely
Tempo: 5-30 minutes each
Associated with sweating, dyspnea, nausea
These are 5 diagnoses that are associated with the history of a 50 yo AFAB with palpitations during exercise
What are: valvular heart disease, coronary artery disease, dysrhythmia, vasomotor symptoms of menopause, hyperthyroidism, anemia, illicit drug use, and anxiety/panic disorder?
These abnormalities suggest ventricular tachycardia
What are frequent premature ventricular contractions?
This is the threshold 10 year ASCVD risk level for medication treatment of Stage 1 Hypertension (130-139/80-89)
What is ≥10%?
This level of statin is indicated for a patient >21 yo with LDL-c > 190 mg/dL
What is a high-intensity statin?
These are 5 of the prodromal symptoms of ACS in patients of female gender
What are: fatigue, dyspnea, numbness, dizziness, back pain, indigestion, nausea/vomiting, cough, palpitations, dyspnea, neck and jaw pain?
These are 4 outpatient studies that can be ordered to evaluate palpitations
What are: EKG, 24-48hr Holter monitor, loop recorder, echocardiogram, CBC, TSH, and urine drug screen?
These abnormalities suggest super ventricular tachycardia and may be associated with Afib
What are short PR intervals and delta waves (Wolff-Parkinson-White syndrome)?
These are the characteristics of the low CVD risk women in the Nurses' Health Study (name at least 4/5 criteria).
Not currently smoking
BMI < 25
Alcohol consumption ≤ 1/2 drink per day
moderate to vigorous physical activity for at least 30 minutes daily
highest consumption of cereal fiber in the cohort
This decade of life is the one indicated for the usage of aspirin for the primary prevention of CVD events and colorectal cancer with a B rating, and this decade of life is indicated with a C rating.
What is the age of 50-59 (B rating) and 60-69 (C rating)?