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Chest Pain Pt Assessment - Coggle Diagram
Chest Pain Pt Assessment
1. Patient Assessment
definition
evaluation of subjective and objective pt specific data to enable decisions regarding: :arrow_down:
decision making
therapy needs
follow up
health status
3. Cardiac Assessment Principles
anatomy
myocardial perfusion/vascular competence
how well blood flows to the heart
pump function
how well the heart pumps blood
electrical conduction
5. Chest Pain Evaluation
common causes and significance
baseline sx
not bad
suggest an OTC like TUMS
emergency
refer to emergency department
urgent
refer to doc
sx after starting drug therapy
how is the medication helping?
parameters for cardiac chest pain
location
retrosternal (behind sternum)
substernal (underneath sternum)
radiation
back
arms
neck, jaw
upper abdomen
this pattern of pain distribution to these places is because the heart has somatic nerves that innervate C8 to T4 back to the brain via efferent neurone (which is why if you feel pain in these certain spots, it's because your heart is sending the signal)
duration
2-5 mins, not more than 10
quality
feels like squeezing, heavy pressure on the chest
discomfort rather than pain
not tender to touch the heart
specific to pericarditis
: changing positions hurts
provokers/relievers
provokers
exertion, emotional distress, extreme temps, eating
relievers
resting
sublingual nitroglycerin acts within minutes (super quick, right away)
classifications (not all chest pain is related to the heart)
possible cardiac (atypical)
2 of the ones from cardiac
common in DM and elderly
non-cardiac
1 of the above or none of the above
might be non-ischemic cardiac, pulmonary, GI, psychiatric causes
cardiac
cardiac chest pain is a sx of
ischemia (inadequate blood flow)
:heartbeat: and/or
infarction (lack of blood flow causing necrosis)
:broken_heart:
substernal with characteristics of QUALITY and DURATION
provoked by exertion or stress
relieved by rest or nitro
Acute Coronary Syndrome
unstable angina
NSTEMI
stable angina
STEMI
CCS Classificaation of angina (Classes I-IV)
Class II
slight limitation of ordinary activity; angina happens when climbing stairs too fast, after eating, in cold temps, under emotional stress :walking: :cold_sweat:
Class III
certain things cause angina that should be ordinary; walking 1-2 blocks, climbing a flight of stairs in normal conditions :walking: :sunny:
Class I
ordinary physical activity is ok; angina happens when strenous, rapid, prolonged exertion occurs :weight_lifter:
Class IV
can't carry on any physical activity without discomfort; angina might be present at rest :sleeping_accommodation:
8. Case Studies
Ms. Prada
Risk factors: dyslipidemia, male; feels stabbing in right side of chest radiating to right shoulder; no associated sx , lasts 20 mins, not provoked by anything, pain at rest
DIAGNOSIS: :check: non cardiac chest pain
Ms. Ma
risk factors: elderly, HTN, dyslipidemia, hx of MI; feels a pressure with no radiation or assoc sx, lasts 20 mins, provoked by exertion/rest/bedtime; relieved by double dose nitro;
described pain as similar to last heart attack
DIAGNOSIS: :checkered_flag:possible cardiac chest pain; refer pt to ED as hx of MI is worrisome
Mr. Ahmed
65yo, risk factors include: elderly, male, HTN, dyslipidemia; pt presents with feeling of pressure, no radiation, no assoc sx, lasts 5 mins, provoked after large meals and walking/climbing stairs; relieved by resting for a minute
DIAGNOSIS: :red_flag: cardiac chest pain; stable angina
9. Next Steps in Pt Assessment
risk factor analysis
interventions and follow up
diagnostic testing
2. Approach to the CV patient
physical exam
risk factors
history
tests
assessment and care plan
7. Differentiating Chest Pain
sources
musculoskeletal
hx of trauma, feels sore/achy/sharp, provoker is physical movement, relieved by rest/heat/pain
GI
hx of indigestion or GERD, feels burning, provoked by food, relieved with antacids
cardiac
hx of risk factors, heavy pressure/crushing/squeezing, exertion or stress is a provoker, relieved by rest or nitro
atypical presentations with associated sx
elderly
diabetics
women
4. Signs and Sx of Stable Angina
orthopnea/PND
fatigue, lightheadedness
dyspnea, nausea
edema
chest pain, palpitations
syncope and pre-syncope
abnormal sweating
6. Unstable Angina
Classifications
new onset angina
pt was a Class III for 2 months, then started having worse and intense sx
increasing angina
worsening in less than 4 weeks, more frequent, longer in duration, lower threshold that causes the angina
rest angina
angina at rest and longer than 20 mins
Compared to stable angina
more severe pain, more associated sx, SOB, sweating, more sudden onset, not provoked by anything, not predictable, not relieved with nitro
occurs when plaque ruptures and a clot forms around it causing partial occlusion of the vessel; angina can occur at rest or progresses rapidly over time