Unit 1 Exam CMN 574. Chest pain, Heart Failure Final Exam Test 2024\2025.
What is the most common cause of chest pain in the primary care office?
Musculoskeletal/ chest wall pain
What are some common causes of chest pain the the primary care setting?
Musculoskeletal.
GI: esophagus, hernia, GERD.
Anxiety/psychiatric disorders.
Respiratory: PNA, pleuritis or sharp chest pain.
Stable angina.
mitral valve prolapse.
inflammatory disorders/ infections.
Approximately ___-____% of patients presenting to the ER have non cardiac chest pain: GI, MS,
psychosomatic disorders.
50-60%
Risk factors are _________ ___________ ______________ that make a serious cardiac event more
likely.
Positive Predictive values
What % of chest pain the the U.S. is musculoskeletal related?
40%: Most common cause of chest pain in the office setting. Most common causes are muscle strain and
costochondritis. could also be broken ribs, herpes zoster, fibromaylgia, sickle cell, protracted vomiting.
A history of chicken pox can lead to chest pain how?
If shingles develop on torso- shingles are very painful. Zoster pain may occur before rash develops.
What percent of chest wall pain is GI related?
20 to 30%: includes GERD, esophagitis, peptic ulcers, hiatal hernias, gallbladder disease.
What population has increased risk of GI ulcers?
Smokers
___ and ____________ may present as epigastric pain radiating to the back (around the shoulder
area).
PUD (peptic ulcer disease) and pancreatitis
___________ causes account for 10-20% of chest pain.
Psychogenic
Dizziness, irritability, rapid breathing, numb fingers, nausea related to chest pain are indicative of
what kind of chest pain?
Psychogenic or anxiety related.
Panic disorder causes what kind of chest pain?
,Unit 1 Exam CMN 574. Chest pain, Heart Failure Final Exam Test 2024\2025.
Precordial: or sharp pains. (Not due to the heart.)
Always ask about ____ ___ _______ medication use, as patients don't think of this as medicine.
Over the Counter: ie. Goody Powders.
GERD presents as what kind of chest pain?
What other symptom may be present?
Substernal and burning pain.
Esophageal spasm presented as substernal squeezing or pressure.
GERD is ________ by meals and ________ by ________, ___, and __ blockers.
GERD is WORSENED by meals and relieved by ANTACIDS, PPI, and H2 BLOCKERS.
What 2 question assessment is used to identify panic disorder, and what identifies a positive
screen for PD?
1. In the past 6 months have you had a spell or an attack when suddenly you felt anxious, frightened or
uneasy?
2. In the past 6 months did you ever have a spell or attack where, for no reason, your heart suddenly
began to race and you felt faint or couldn't catch your breath?
YES to EITHER is a POSITIVE screen.
Which type of disorders account for 5-10% of chest pain patients and what does this include?
RESPIRATORY DISORDERS account for 5-10% of C.P patients and include: bronchitis, Pneumonia, asthma,
COPD, pneumonitis, pleurisy, P.E.
Prolonged immobilization, pregnancy, pelvic or lower leg trauma, hypercoagulabiltiy, estrogen
use, smoking, and cancer are risk factors for _________ ________.
PE: pulmonary embolism
What is the test used for predicting risk for P.E?
Wells Score: the lower the score the lower the probability of a PE.
<2=low risk 1-28%.
2 to 6=moderate 28-40%.
>6=high 38-91%.
Pneumonia presents with what kind of pain?
Dull or no pain. Sometimes pleuritic pain.
Pleuritic (PE, pleuritis) pain presents how?
Sharp, stabbing, usually localized to one side, worse with deep breathing or coughing.
CXR is used to rule out what?
Pneumonia
D-dimer, helical CT, venous ultrasound are used to rule out what?
, Unit 1 Exam CMN 574. Chest pain, Heart Failure Final Exam Test 2024\2025.
Pulmonary embolism. WELLS score would be first test.
What is the treatment for:
a. pneumonia.
b. pulmonary embolism?
a. antibiotics.
b. anticoagulation.
Cardiac chest pain can be both non-ischemic and ischemic. What are 3 examples of non-ischemic
cardiac chest pain?
1. mitral valve prolapse
2. pericarditis
3. aortic dissection
What are 3 examples of ischemic cardiac chest pain?
1. stable angina
2. unstable angina
3. acute coronary syndrome/AMI
PE pain is sudden and aggravated with breathing, coughing.
True or False
True: PE pain is sudden and may present with fever (infection), egophony, rales, wheezes, friction rub
(pericarditis), tachycardia.
Non-ischemic cardiac chest pain is usually asymptomatic and treatments include low dose beta
blockers, SSRIs and mitral valve repair if necessary. True or False?
True. Low dose beta blockers for hyperadrenergic states or arrhythmias, and mitral valve repair if mitral
regurgitation is a problem.
Clinical signs and symptoms of DVT scores how many points on the Wells Model for PE?
3.0 points (slide 16 in
PP or pg
313t)
What non-ischemic cardiac issue is usually asymptomatic, is found in up to 10% of healthy
females, is found in those with collagen disease such as Marfan's or Ehlers-Danlos, presents with
pansystolic murmur, mid-systolic click and possibly pectus excavatum or scoliosis?
Mitral Valve Prolapse
confirmed by echo and treated with Beta blockers, SSRI's and mitral valve repair if regurg is a problem.
Most with MVP don't know they have it because are asymptomatic. May have pansystolic murmur.
What is the most common cause of chest pain in the primary care office?
Musculoskeletal/ chest wall pain
What are some common causes of chest pain the the primary care setting?
Musculoskeletal.
GI: esophagus, hernia, GERD.
Anxiety/psychiatric disorders.
Respiratory: PNA, pleuritis or sharp chest pain.
Stable angina.
mitral valve prolapse.
inflammatory disorders/ infections.
Approximately ___-____% of patients presenting to the ER have non cardiac chest pain: GI, MS,
psychosomatic disorders.
50-60%
Risk factors are _________ ___________ ______________ that make a serious cardiac event more
likely.
Positive Predictive values
What % of chest pain the the U.S. is musculoskeletal related?
40%: Most common cause of chest pain in the office setting. Most common causes are muscle strain and
costochondritis. could also be broken ribs, herpes zoster, fibromaylgia, sickle cell, protracted vomiting.
A history of chicken pox can lead to chest pain how?
If shingles develop on torso- shingles are very painful. Zoster pain may occur before rash develops.
What percent of chest wall pain is GI related?
20 to 30%: includes GERD, esophagitis, peptic ulcers, hiatal hernias, gallbladder disease.
What population has increased risk of GI ulcers?
Smokers
___ and ____________ may present as epigastric pain radiating to the back (around the shoulder
area).
PUD (peptic ulcer disease) and pancreatitis
___________ causes account for 10-20% of chest pain.
Psychogenic
Dizziness, irritability, rapid breathing, numb fingers, nausea related to chest pain are indicative of
what kind of chest pain?
Psychogenic or anxiety related.
Panic disorder causes what kind of chest pain?
,Unit 1 Exam CMN 574. Chest pain, Heart Failure Final Exam Test 2024\2025.
Precordial: or sharp pains. (Not due to the heart.)
Always ask about ____ ___ _______ medication use, as patients don't think of this as medicine.
Over the Counter: ie. Goody Powders.
GERD presents as what kind of chest pain?
What other symptom may be present?
Substernal and burning pain.
Esophageal spasm presented as substernal squeezing or pressure.
GERD is ________ by meals and ________ by ________, ___, and __ blockers.
GERD is WORSENED by meals and relieved by ANTACIDS, PPI, and H2 BLOCKERS.
What 2 question assessment is used to identify panic disorder, and what identifies a positive
screen for PD?
1. In the past 6 months have you had a spell or an attack when suddenly you felt anxious, frightened or
uneasy?
2. In the past 6 months did you ever have a spell or attack where, for no reason, your heart suddenly
began to race and you felt faint or couldn't catch your breath?
YES to EITHER is a POSITIVE screen.
Which type of disorders account for 5-10% of chest pain patients and what does this include?
RESPIRATORY DISORDERS account for 5-10% of C.P patients and include: bronchitis, Pneumonia, asthma,
COPD, pneumonitis, pleurisy, P.E.
Prolonged immobilization, pregnancy, pelvic or lower leg trauma, hypercoagulabiltiy, estrogen
use, smoking, and cancer are risk factors for _________ ________.
PE: pulmonary embolism
What is the test used for predicting risk for P.E?
Wells Score: the lower the score the lower the probability of a PE.
<2=low risk 1-28%.
2 to 6=moderate 28-40%.
>6=high 38-91%.
Pneumonia presents with what kind of pain?
Dull or no pain. Sometimes pleuritic pain.
Pleuritic (PE, pleuritis) pain presents how?
Sharp, stabbing, usually localized to one side, worse with deep breathing or coughing.
CXR is used to rule out what?
Pneumonia
D-dimer, helical CT, venous ultrasound are used to rule out what?
, Unit 1 Exam CMN 574. Chest pain, Heart Failure Final Exam Test 2024\2025.
Pulmonary embolism. WELLS score would be first test.
What is the treatment for:
a. pneumonia.
b. pulmonary embolism?
a. antibiotics.
b. anticoagulation.
Cardiac chest pain can be both non-ischemic and ischemic. What are 3 examples of non-ischemic
cardiac chest pain?
1. mitral valve prolapse
2. pericarditis
3. aortic dissection
What are 3 examples of ischemic cardiac chest pain?
1. stable angina
2. unstable angina
3. acute coronary syndrome/AMI
PE pain is sudden and aggravated with breathing, coughing.
True or False
True: PE pain is sudden and may present with fever (infection), egophony, rales, wheezes, friction rub
(pericarditis), tachycardia.
Non-ischemic cardiac chest pain is usually asymptomatic and treatments include low dose beta
blockers, SSRIs and mitral valve repair if necessary. True or False?
True. Low dose beta blockers for hyperadrenergic states or arrhythmias, and mitral valve repair if mitral
regurgitation is a problem.
Clinical signs and symptoms of DVT scores how many points on the Wells Model for PE?
3.0 points (slide 16 in
PP or pg
313t)
What non-ischemic cardiac issue is usually asymptomatic, is found in up to 10% of healthy
females, is found in those with collagen disease such as Marfan's or Ehlers-Danlos, presents with
pansystolic murmur, mid-systolic click and possibly pectus excavatum or scoliosis?
Mitral Valve Prolapse
confirmed by echo and treated with Beta blockers, SSRI's and mitral valve repair if regurg is a problem.
Most with MVP don't know they have it because are asymptomatic. May have pansystolic murmur.
