CMN 574 Cardiac Unit 1 Exam with verified detailed ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
solutions
Musculoskeletal CP - correct answer✔✔Usually more localized and pt can point to it ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Made worse with movement/deep inspiration
||\\//|| ||\\//|| ||\\//|| ||\\//||
Often reproducible ||\\//||
*Examen for rash associated with zoster ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
X-rays if hx of trauma ||\\//|| ||\\//|| ||\\//|| ||\\//||
Tx: Rest, anti-inflammatories, ice/heat
||\\//|| ||\\//|| ||\\//||
Gastrointestinal CP - correct answer✔✔(always ask about OTC pain meds) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Substernal, burning pain, nocturnal cough, flatus, belching, dysphagia ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Esophageal spasm -> squeezing or pressure ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Epigastric pain radiating to back -->Pelvic Ulcer disease, pancreatitits ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Usually recurrent, worsened by meals/supine ||\\//|| ||\\//|| ||\\//|| ||\\//||
Relieved by antacids, PPI, H2 blockers ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Tx: PPIs, ABX for H. pylori, Diet, Elevate HOB
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Psychogenic CP - correct answer✔✔Precordial CP ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
constant or intermittent heaviness unrelated to meals or activity ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Screening Questions ||\\//||
1. In past 6 mos, any spell/attack where suddenly felt anxious, frightened, uneasy?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
2. In past 6 mos, suddenly heart race, felt faint, or couldn't breathe?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,*Yes to either is positive screen. No makes panic disorder unlikely
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Mitral Valve Prolapse - correct answer✔✔Usually asymptomatic but can have non-specific CP,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
dyspnea, palpitations
||\\//|| ||\\//||
Inc risk in healthy females, thin collagen disease (Marfan's, Ehlers-Danlos Syndrome)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Pansystolic or late systole with single to multiple mid-systolic click ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Skeletal changes such as pectus excavatum or scoliosis ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Diagnosis confirmed by echo, ambulatory ECG (palpitations) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Tx: Low dose BB, mitral valve repair
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Aortic aneurysm/dissection - correct answer✔✔abrupt onset severe, tearing, ripping, knife-
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
like CP radiating to back
||\\//|| ||\\//|| ||\\//|| ||\\//||
s/s: anxiety, dyspnea, hypo/hyperTN, difference between R& L arm BP, absent UE pulses
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
harsh holosystolic murmur ||\\//|| ||\\//||
Tx: Emergent chest CT and echo--> Surgery!!
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Pericarditis - correct answer✔✔Pleuritic substernal CP radiates to shoulders, back, ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
epigastrium
, Worse when supine, +Fever, +dyspnea ||\\//|| ||\\//|| ||\\//|| ||\\//||
Caused by virus/bacteria/autoimmune ||\\//|| ||\\//||
Dx: CBC, Sed rate, cardiac enzymes, ECG, echo
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Tx: Bedrest, ASA, NSAIDS, Colchicine, Steroids
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Risk factors for CAD - correct answer✔✔Male
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Increased age ||\\//||
Fam Hx ||\\//||
Dyslipidemia
HTN
DM
Smoking
Sedentary
Obesity (esp abd) ||\\//|| ||\\//||
Stress
Poor diet ||\\//||
ETOH (excessive) ||\\//||
Rouan Decision Rule - correct answer✔✔Predicts when pts with CP (but normal ECG) are at
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
high risk for MI Mnemonic-An MI rouans your life
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Respiratory CP - correct answer✔✔Pleuritic, dull, sharp, or stabbing- worse with deep breath ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
or cough, fever, dyspnea
||\\//|| ||\\//|| ||\\//|| ||\\//||
Labs: CXR (PNA), D-dimer or helical CT and venous US (PE)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
solutions
Musculoskeletal CP - correct answer✔✔Usually more localized and pt can point to it ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Made worse with movement/deep inspiration
||\\//|| ||\\//|| ||\\//|| ||\\//||
Often reproducible ||\\//||
*Examen for rash associated with zoster ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
X-rays if hx of trauma ||\\//|| ||\\//|| ||\\//|| ||\\//||
Tx: Rest, anti-inflammatories, ice/heat
||\\//|| ||\\//|| ||\\//||
Gastrointestinal CP - correct answer✔✔(always ask about OTC pain meds) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Substernal, burning pain, nocturnal cough, flatus, belching, dysphagia ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Esophageal spasm -> squeezing or pressure ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Epigastric pain radiating to back -->Pelvic Ulcer disease, pancreatitits ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Usually recurrent, worsened by meals/supine ||\\//|| ||\\//|| ||\\//|| ||\\//||
Relieved by antacids, PPI, H2 blockers ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Tx: PPIs, ABX for H. pylori, Diet, Elevate HOB
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Psychogenic CP - correct answer✔✔Precordial CP ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
constant or intermittent heaviness unrelated to meals or activity ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Screening Questions ||\\//||
1. In past 6 mos, any spell/attack where suddenly felt anxious, frightened, uneasy?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
2. In past 6 mos, suddenly heart race, felt faint, or couldn't breathe?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,*Yes to either is positive screen. No makes panic disorder unlikely
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Mitral Valve Prolapse - correct answer✔✔Usually asymptomatic but can have non-specific CP,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
dyspnea, palpitations
||\\//|| ||\\//||
Inc risk in healthy females, thin collagen disease (Marfan's, Ehlers-Danlos Syndrome)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Pansystolic or late systole with single to multiple mid-systolic click ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Skeletal changes such as pectus excavatum or scoliosis ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Diagnosis confirmed by echo, ambulatory ECG (palpitations) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Tx: Low dose BB, mitral valve repair
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Aortic aneurysm/dissection - correct answer✔✔abrupt onset severe, tearing, ripping, knife-
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
like CP radiating to back
||\\//|| ||\\//|| ||\\//|| ||\\//||
s/s: anxiety, dyspnea, hypo/hyperTN, difference between R& L arm BP, absent UE pulses
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
harsh holosystolic murmur ||\\//|| ||\\//||
Tx: Emergent chest CT and echo--> Surgery!!
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Pericarditis - correct answer✔✔Pleuritic substernal CP radiates to shoulders, back, ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
epigastrium
, Worse when supine, +Fever, +dyspnea ||\\//|| ||\\//|| ||\\//|| ||\\//||
Caused by virus/bacteria/autoimmune ||\\//|| ||\\//||
Dx: CBC, Sed rate, cardiac enzymes, ECG, echo
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Tx: Bedrest, ASA, NSAIDS, Colchicine, Steroids
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Risk factors for CAD - correct answer✔✔Male
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Increased age ||\\//||
Fam Hx ||\\//||
Dyslipidemia
HTN
DM
Smoking
Sedentary
Obesity (esp abd) ||\\//|| ||\\//||
Stress
Poor diet ||\\//||
ETOH (excessive) ||\\//||
Rouan Decision Rule - correct answer✔✔Predicts when pts with CP (but normal ECG) are at
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
high risk for MI Mnemonic-An MI rouans your life
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Respiratory CP - correct answer✔✔Pleuritic, dull, sharp, or stabbing- worse with deep breath ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
or cough, fever, dyspnea
||\\//|| ||\\//|| ||\\//|| ||\\//||
Labs: CXR (PNA), D-dimer or helical CT and venous US (PE)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
