Unit 1 Exam CMN 574. Chest pain,
Heart Failure
What is the most common cause of chest pain in the primary care office? - answer
Musculoskeletal/ chest wall pain
What are some common causes of chest pain the the primary care setting? - answer
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. - answer50-60%
Risk factors are _________ ___________ ______________ that make a serious
cardiac event more likely. - answer Positive Predictive values
What % of chest pain the the U.S. is musculoskeletal related? - answer40%: 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? - answerIf shingles develop on
torso- shingles are very painful. Zoster pain may occur before rash develops.
What percent of chest wall pain is GI related? - answer20 to 30%: includes GERD,
esophagitis, peptic ulcers, hiatal hernias, gallbladder disease.
What population has increased risk of GI ulcers? - answerSmokers
___ and ____________ may present as epigastric pain radiating to the back (around
the shoulder area). - answerPUD (peptic ulcer disease) and pancreatitis
___________ causes account for 10-20% of chest pain. - answerPsychogenic
Dizziness, irritability, rapid breathing, numb fingers, nausea related to chest pain are
indicative of what kind of chest pain? - answerPsychogenic or anxiety related.
,Panic disorder causes what kind of chest pain? - answerPrecordial: or sharp pains. (Not
due to the heart.)
Always ask about ____ ___ _______ medication use, as patients don't think of this as
medicine. - answerOver the Counter: ie. Goody Powders.
GERD presents as what kind of chest pain?
What other symptom may be present? - answerSubsternal and burning pain.
Esophageal spasm presented as substernal squeezing or pressure.
GERD is ________ by meals and ________ by ________, ___, and __ blockers. -
answerGERD 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? - answer1. 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? - answerRESPIRATORY 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 _________ ________. -
answerPE: pulmonary embolism
What is the test used for predicting risk for P.E? - answerWells 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? - answerDull or no pain. Sometimes
pleuritic pain.
Pleuritic (PE, pleuritis) pain presents how? - answerSharp, stabbing, usually localized to
one side, worse with deep breathing or coughing.
CXR is used to rule out what? - answerPneumonia
D-dimer, helical CT, venous ultrasound are used to rule out what? - answerPulmonary
embolism. WELLS score would be first test.
, What is the treatment for:
a. pneumonia.
b. pulmonary embolism? - answera. antibiotics.
b. anticoagulation.
Cardiac chest pain can be both non-ischemic and ischemic. What are 3 examples of
non-ischemic cardiac chest pain? - answer1. mitral valve prolapse
2. pericarditis
3. aortic dissection
What are 3 examples of ischemic cardiac chest pain? - answer1. stable angina
2. unstable angina
3. acute coronary syndrome/AMI
PE pain is sudden and aggravated with breathing, coughing.
True or False - answerTrue: 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? -
answerTrue. 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? - answer3.0 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? - answerMitral 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.
Which non-ischemic cardiac issue is an emergency with patient presenting to ER c/o
abrupt onset of ripping, tearing, knife-like CP radiating to back: - answerAortic
aneurysm/dissection
**Requires emergent chest CT, Echo, & surgery.
What would the exam findings be of a patient suffering an aortic aneurysm/dissection? -
answeranxiety, dyspnea, differences in BP in Right and Left arms, absence of upper
extremity pulses, harsh holosystolic murmur.
Heart Failure
What is the most common cause of chest pain in the primary care office? - answer
Musculoskeletal/ chest wall pain
What are some common causes of chest pain the the primary care setting? - answer
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. - answer50-60%
Risk factors are _________ ___________ ______________ that make a serious
cardiac event more likely. - answer Positive Predictive values
What % of chest pain the the U.S. is musculoskeletal related? - answer40%: 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? - answerIf shingles develop on
torso- shingles are very painful. Zoster pain may occur before rash develops.
What percent of chest wall pain is GI related? - answer20 to 30%: includes GERD,
esophagitis, peptic ulcers, hiatal hernias, gallbladder disease.
What population has increased risk of GI ulcers? - answerSmokers
___ and ____________ may present as epigastric pain radiating to the back (around
the shoulder area). - answerPUD (peptic ulcer disease) and pancreatitis
___________ causes account for 10-20% of chest pain. - answerPsychogenic
Dizziness, irritability, rapid breathing, numb fingers, nausea related to chest pain are
indicative of what kind of chest pain? - answerPsychogenic or anxiety related.
,Panic disorder causes what kind of chest pain? - answerPrecordial: or sharp pains. (Not
due to the heart.)
Always ask about ____ ___ _______ medication use, as patients don't think of this as
medicine. - answerOver the Counter: ie. Goody Powders.
GERD presents as what kind of chest pain?
What other symptom may be present? - answerSubsternal and burning pain.
Esophageal spasm presented as substernal squeezing or pressure.
GERD is ________ by meals and ________ by ________, ___, and __ blockers. -
answerGERD 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? - answer1. 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? - answerRESPIRATORY 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 _________ ________. -
answerPE: pulmonary embolism
What is the test used for predicting risk for P.E? - answerWells 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? - answerDull or no pain. Sometimes
pleuritic pain.
Pleuritic (PE, pleuritis) pain presents how? - answerSharp, stabbing, usually localized to
one side, worse with deep breathing or coughing.
CXR is used to rule out what? - answerPneumonia
D-dimer, helical CT, venous ultrasound are used to rule out what? - answerPulmonary
embolism. WELLS score would be first test.
, What is the treatment for:
a. pneumonia.
b. pulmonary embolism? - answera. antibiotics.
b. anticoagulation.
Cardiac chest pain can be both non-ischemic and ischemic. What are 3 examples of
non-ischemic cardiac chest pain? - answer1. mitral valve prolapse
2. pericarditis
3. aortic dissection
What are 3 examples of ischemic cardiac chest pain? - answer1. stable angina
2. unstable angina
3. acute coronary syndrome/AMI
PE pain is sudden and aggravated with breathing, coughing.
True or False - answerTrue: 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? -
answerTrue. 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? - answer3.0 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? - answerMitral 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.
Which non-ischemic cardiac issue is an emergency with patient presenting to ER c/o
abrupt onset of ripping, tearing, knife-like CP radiating to back: - answerAortic
aneurysm/dissection
**Requires emergent chest CT, Echo, & surgery.
What would the exam findings be of a patient suffering an aortic aneurysm/dissection? -
answeranxiety, dyspnea, differences in BP in Right and Left arms, absence of upper
extremity pulses, harsh holosystolic murmur.
