cardio 1a

Case 1: 45 year old woman with intermittent CP, no PMHx: 

Case 1: 45 year old woman with intermittent CP, no PMHx initial (most likely) dx? noncardiac CP = GERD initial test? EKG r/o worst case, noninvasive

Case 2: same as Case 1, but with risk factors for CAD (“CHOSED A BF”): 

Case 2: same as Case 1, but with risk factors for CAD (“CHOSED A BF”) correcting all of these will improve mortality cholesterol (low HDL, not including TRG) HTN (meds, regardless of #’s, most common (5X> than DM) obesity: dependent risk factor smoking (10+cigarettes daily): most effect on mortality exercise: dependent risk factor DM = CAD age: 45 male, 55 female boy: but if over 45, don’t count gender against him FHx: sudden death from MI :55 male, 65 female 1st degree relative

Case 3: 65 year old man with CP: 

Case 3: 65 year old man with CP most likely dx? cardiac CP = ischemic heart disease

“Most common cause of…”?: 

“Most common cause of…”? these questions are about epidemiology and statistics answer is usually the most common dz hemoptysis? bronchitis, not TB/CA a-fib? HTN, not pheo/hypothyroidism/PE/MS

Chest pain: key point to remember: 

Chest pain: key point to remember it’s character determines next step in management regardless of risk factors

Chest pain: MI: 

Chest pain: MI most common cause of death in men and woman # of woman MI mortalities > # of deaths from next 4 most common causes of death chest pain from MI on boards is not very characteristic nonpalpational, nonpleuritic, nonpositional in real life 4% of the time can be any of above, but can’t ask “?” MI = coronary clot therefore ups the CBC, ESR, body temp was used for dx before enzymes were available fever seen in all types of CP inflammation/infection, clot/bleed—such as an MI, atelectasis SOB is seen in all types of CP severe SOB (dypsnea) not seen in all types of CP MI doesn’t ? dypsnea unless CHF (severe hypoxia)

Chest pain: pleuritic: 

Chest pain: pleuritic all start with a “P” and most are pulmonary inflammatory/infectious: pleuritis/pericarditis, pneumonia clot/bleed: PE/DVT, postpartum (bleed into “cul-de-sac”) atelectasis: pneumothorax (i.e. post-op fever) PE/pneumothorax ? dyspnea

Chest pain: positional: 

Chest pain: positional pericarditis: changes with leaning better leaning forward worse leaning backward due to stretching of pericardial sac

Chest pain: palpational: 

Chest pain: palpational costochondritis ? chest wall tenderness

Case 4: 45 year old woman with exertional, intermittent CP, no PMHx shows up to your office without any CP: 

Case 4: 45 year old woman with exertional, intermittent CP, no PMHx shows up to your office without any CP initial test? EKG—done for all CP to r/o MI NL EKG: next step? cardiac-type CP ? stress test noncardiac-type CP ? GI evaluation

Stress test: 

Stress test exercise tolerance most common read EKG while patient walks on treadmill patient must reach exertion 85% of maximal HR = 85% of (220-age) EKG must be readable no cardiac abnormalities to obscure report is there cardiac ischemia? ST segment depression @ exertion stop test if patient becomes hypotensive, has CP, ST elevation… will continue discussion in next video…stay tuned