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approach to chest pain, palpitations, lower extremity pain and edema Terms in this set (99) The initial pivotal points in the evaluation of chest pain are the (3) duration of symptoms, the patient’s vital signs, and ECG . Acute: Subacute: Chronic : Acut$9.49
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CIMP - Certificate In Investment Performance Measurement
CIMP - Certificate in Investment Performance Measurement
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approach to chest pain, palpitations, lower extremity pain and edema Terms in this set (99) The initial pivotal points in the evaluation of chest pain are the (3) duration of symptoms, the patient’s vital signs, and ECG . Acute: Subacute: Chronic : Acut
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CIMP - Certificate in Investment Performance Measurement
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CIMP - Certificate In Investment Performance Measurement
approach to chest pain, palpitations, lower extremity pain and edema
Terms in this set (99)
The initial pivotal points in the evaluation of chest pain are the (3) duration of symptoms, the patient’s vital signs, and ECG .
Acute:
Subacute:
Chronic : Acute < 2 weeks Subacute: < 3 month...
what constitutes a chest pain emergency? Acute CP and/or unstable vital signs and/or abnormal ECG
Step 1 (even before/while obtaining history) = ECG, VS
first 2 steps of a approaching a pt with acute
chest pain Step 2 = Characterize the CP, focus on "do not miss diagnoses" = AAS (acute aortic
syndrome), ACS, PE
disorders of the thoracic and abdominal aorta that are usually symptomatic and require
Acute Aortic Syndrome (AAS)
urgent evaluation and consideration for surgical intervention (aortic dissection)
Pulmonary Embolism (PE) blood clot in pulmonary arteries.
Discomfort in the chest and/or adjacent areas ( jaw, shoulder, back, arm), usually, but
not always, due to myocardial ischemia.
Angina + diff types
Typical vs atypical angina
Stable vs unstable angina
Noncardiac Chest Pain = Chest pain that meets only 1 or none of the typical angina characteristics.
Substernal chest discomfort PLUS all of the following:
Characteristic oppressive quality
Typical Angina
Provoked by exertion or emotional stress.
Relieved by rest or nitroglycerin
Substernal chest discomfort PLUS 2 typical features.
Atypical Angina
More common in women
approach to chest pain, palpitations, lower extremity pain and edema
Stable (chronic coronary syndromes) Chronic and recurring episodes without any change in symptom pattern
angina
Angina presenting as rest angina, severe new-onset angina, or acceleration of
Unstable
previously diagnosed effort angina.
What does the CP feel like?
Oppressive, substernal discomfort is classic for angina
Do you have it when you get up and exert yourself?
what questions do we always ask to identify Does it go away with rest?
ischemic sxs of a pt with chest pain? (5) Do you notice it traveling anywhere else?
Radiation to L/R, jaw or both arms/shoulders is concerning for cardiac etiology
Are you sweaty with it? Do you feel nauseous? Dizzy?
These associated symptoms are concerning for cardiac etiology
Typical angina that is prolonged or occurs unstable angina
at rest
1/8
, 8/8/24, 2:13 PM
look at risk factors such as
Diabetes
Smoking
Atypical angina that is prolonged or occurs
Hypertension
at rest with high probability of CAD, what to
Hyperlipidemia
ask next?
Family history of premature CAD
Postmenopausal status
Peripheral vascular disease
Cocaine use (sympathetic system toxicity)
very brief pain lasting less than 15 seconds
dull, localized (< 3 cm) pain, especially in the inframammary region
The following features suggest causes other
than angina/cardiac etiology (4)
localized, superficial chest pain reproduced by palpation
radiation to the upper jaw or below the umbilicus
once you rule out ACS/MI with ECG of a pt PE and acute aortic syndrome
with acute chest pain, what are the other "do
no miss" dxs to look for?
Sudden onset severe "tearing" or "ripping" pain
classic sxs of acute aortic syndrome (aortic
Severe persistent pain radiating to the back
dissection)
Severe migrating chest and back pain
Hypertension
classic signs of acute aortic syndrome Pulse discrepancy in the extremities. (diminished or unequal)
(aortic dissection)
A diastolic murmur may develop due to dissection in the ascending aorta close to the
aortic valve, causing valvular regurgitation
sudden onset of shortness of breath and severe chest pain that increases with
inspiration
("pleuritic chest pain").
classic sxs of PE
+ / - hemoptysis
Associated unilateral leg swelling
pleuritic
approachchest painto chest pain
chest pain, palpitations, that increases
lower with inspiration
extremity pain and edema
2/8
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