Flashcards in this deck (13)

• What is the classic angina triad?

  • Substernal chest pain
  • Worse with stress/exertion
  • Relieved by rest or TNG
  cardiology angina
• What are anginal equivalents?

  • Chest pain/pressure/tightness
  • Discomfort in chest/shoulders/arms/neck/back/upper abdomen/jaw
  • SOB and fatigue
  cardiology angina
• What symptoms might women and the elderly experience with angina?

  • Vague symptoms
  • Palpitations
  • Jaw/neck/back pain
  • SOB
  • N/V
  • Abdominal pain
  • (Pre-) syncope
  cardiology angina
• What are the antianginal medications?

  • Nitrates - avoid if preload sensitive (HoTN, AS, recent PDEi)
  • BB - (careful in ADHF, long PR, 2°/3° AV block)
  • CCB - if BB intolerant
  • Ranolazine
  cardiology medications
• What are the physical exam findings for angina/ACS?

  • Distress, diaphoresis
  • New S4, MR
  • CHF signs
  • Bruits
  • Frank’s sign
  • Les likely ACS - pleuritic, positional, reproducible by palpation
  cardiology physical_exam
• What is a key symptom of acute aortic syndromes?

  • Abrupt onset of tearing/sharp thoracic or abdominal pain

  Physical Exam: BP variation >20mmHg between arms, pulse deficits, new diastolic murmur, focal neurologic changes
  cardiology aortic_syndrome
• What are the risk factors for acute aortic syndromes?

  • Known aneurysm
  • Marfan syndrome
  • CTD
  • HTN
  • M:F 2:1
  • 60-80 yrs
  • Cocaine use
  cardiology aortic_syndrome
• What characterizes acute pericarditis?

  • Pleuritic, sharp pain
  • Improves upon leaning forward
  • May have URI prodrome; consider bacterial pericarditis if high fevers.

  Physical Exam: Friction rub (breath hold to distinguish from pleural rub); tamponade (pulsus >10)
  cardiology pericarditis
• What are the physical exam findings for pulmonary embolism?

  • Tachycardia
  • Tachypnea
  • Hypoxemia
  • Calf/thigh erythema
  cardiology pulmonary_embolism
• What is the Wells criteria for PE?

  • Clinical signs of DVT +3
  • PE is #1 diagnosis +3
  • Heart rate > 100 +1.5
  • Recent immobilization or surgery +1.5
  • Previous PE or DVT +1.5
  • Hemoptysis +1
  • Malignancy/ treatment within 6 months or palliative +1
  cardiology pulmonary_embolism
• What are the risk factors for pneumothorax?

  • 20-40y
  • Tall stature
  • FH or personal history
  • Smoker
  • Known emphysema

  Physical Exam: Ipsilateral absence of breath sounds, contralateral deviation of trachea
  cardiology pneumothorax
• What are the physical exam findings for pneumonia?

  • Bronchial breath sounds
  • Crackles
  • Dullness
  cardiology pneumonia
• What are other causes of chest pain?

  • Cardiac: HOCM, AS, vasospasm
  • MSK: costochondritis
  • GI: GERD, PUD
  • Psych: panic attack
  cardiology chest_pain