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372422
chest pain
Descrição
FOCP- cardio Mapa Mental sobre chest pain, criado por greenfylde em 19-11-2013.
Sem etiquetas
focp- cardio
focp- cardio
Mapa Mental por
greenfylde
, atualizado more than 1 year ago
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Criado por
greenfylde
mais de 10 anos atrás
49
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Resumo de Recurso
chest pain
Ischemic heart disease
MI
NSTEMI
Incomplete occlusion (varies in intens, not usu as bad as STEMI
STEMI
Complete occlusion of vssl (usually atheroma -> thrombus, ruptures, maybe embolus)
diag: Hx, ECG,raised troponin I and T, CK-MB
symps/signs
severe chest pain >20min
doesn't respond to GTN
may rad to L arm/jaw
autonomic symps: sweaty, clammy, pale
thready pulse w/signif hypotens, brady or tachycardia
investigs:
ECG
first mins: ST up
first hrs: T waves invert, R wave voltage down, Q waves devel
days: ST to normal
T wave may return to upright, q wave remains
blood samples
troponin I or T; CK-MB
FBC, serum electrolytes (U+ E's), glucose, lipid profile
echo (transthoracic)
wall motion abnorms (detectable early)
treatment
A+ E: chew aspirin, clopidogrel, GTNx2, oxygen, opiate, B-blocker
PCI (w/in 90mins if avail)
Fibrinolysis (first 6-12 hrs)
Post MI: lifestyle modific, Aspirin, B-blocker, ACE inhibitor, Statin, Clopidogrel, Aldosterone antag
myocytes die due to ischemia
diag: Hx, ECG, biochem markers (troponin 1 and T, CK-MB)
Clin Present: new onset/at rest chest pain or deteriorating angina
Exam: detect alt diags (aortic dissect, PE, peptic ulcer), detect adverse clin signs (hypotens, basal crackles, 4th heart sound, heart murmurs)
treatment
aspririn, antithrombins (eg warfarin), B-blockers, statins, ACE inhibitors,
if hi risk: stenting, CABG
Risk factor modif
Investigs
ECG: ST depression and T wave inversion highly suggestive of ACS
Troponin, CK-MB
If high risk for MI or death- urgent coronary angiography
Angina
pain characteristics
heavy tight gripping
central/retrosternal
may rad to jaw/arms
mild to severe
maybe breathlesss
classical triggers
exercise
cold
after meals
emotion
exam
usually no abnorm findings
exclude aortic stenosis
BP (for coexist HBP)
look for signs of anemia, thyrotoxicosis, hyperlipidemia
investigations
exercise ECG (ST depresss of >1mm suggests myocard ischemia)
echo (for ventric func or wall abnorms)
CT coronary angio- helps diag CAD, exclude PE
treatment
Correct risk factors
Medical: prophylaxis aspirin, statin/fibrate; symptomatic GTN; prophylax choose 1+of: B-blockers, Longact nitrates, CCB, (also verpamil or diltiaszem but not w/BBlockers)
Surgical: revascularization
PCI
CABG
Causes: mech obstruct (CAD-atheroma, throbmosis/embolus, spasm, stensosis) OR decreased flow (anemia, hypotension, etc)
CAD is biggest single cause of death in UK. inflam -> lesions -> fatty deposits -> complicated plaques -> thrombi
CAD RISK FACTORS:
fixed: age, male, FH, deletion in ACE gene
changeable: hyperlipidemia, high alcohol, smoke, hypertension, DM, exercise, blood coag, personality, obesity, gout, drugs (COC, nucleoside anaolgues, COX-2 inhibitors, rosiglitazone) homocysteinemai, C-RP
PE
if large: sudden, severe. dypnea, haemoptysis, syncope, previous DVT. maybe no symps
Pneumonia
pleuritic pain (sharp, stabbing). assoc breathless. maybe hyperres, decreased breathsounds. do CXR
GORD
burning, may rad upward. worse supine, maybe after meals. recent weight gain?
Anxiety
panic attacks. ask ice (reassure not heart attack)
assoc feats: breathless 'inabil to get enough air,' tingling around mouth, onset of symps coincides w/stress
(others: aortic dissection, acute pericarditis, pneumothorax
dissection: ripping, maybe shoulder pain, severe, autonomic symps, ?shock
pericard: worse on insp/lying, eased by sit forward. constant, sharp stabbing. maybe rub on auscult
pneumothorax: unilat sudden onset pleuritic. w/breathless. take CXR
Aortic stenosis
causes: progressive calfic due to: congen, rheumatic fever, AGE
pathophys: causes less LV empty, so LV press up + hypertrophy -> LV ischemia -> angina, arryth, LV fail
symp: presents LATE: angina, exercise induced syncope, dyspnea
for diff diag: check no obstruction to LV empty (eg hypertrophy)
signs: slow rising pulse, maybe systolic thrill, may feel 4th sound (dbl impulse), EJECTION SYSTOLIC MUMUR (crescendo decresenco- diamond shaped) (other signs: systolic ejeciton slick, soft 2nd HS, prominent 4th sound)
investig
CXR: small heart, dilated asc aorta
ECG: LV hypertrophy + L atrial delay
strain pattern: depressed sT seg, T wave inversion in lleads orientated toward LV
echocardiogram
thickened, calcif + immobile, aortic valve cusps, maybe LV hypertroph
treatment
if symptomatic: valve replace
Muscskel
worse on move? may respond to NSAIDS
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