EVALUATION OF CHEST

PAIN ..............................................................................
.......................................................5
EVALUATION OF CHEST PAIN IN EMERGENCY
DEPARTMENT ........................................................................
............6
ATYPICAL SYMPTOMS IN ACUTE CORONARY
SYNDROME ..........................................................................
...............6
MEDICATION TO WITHOLD PRIOR TO CARDIAC STRESS
TESTING............................................................................
..7
DIFFERENTIAL DIAGNOSIS OF CHEST
PAIN ..............................................................................
...................................7
TREATMENT FOR STABLE CHRONIC
ANGINA ............................................................................
.................................8
VARIANT/PRINZMETAL
ANGINA ............................................................................
.....................................................8
MYOCARDIAL
INFARCTION ........................................................................
.................................................................9
Right ventricular
MI: ...............................................................................
................................................................9
Inferior and posterior wall MI (RCA in
ECG): .............................................................................
.......................... 10
POST-MI
COMPLICATIONS .....................................................................
.............................................................. 11
Ventricular
arrhythmias: ......................................................................
........................................................... 12
Ventricular free wall
rupture: ..........................................................................
................................................ 12
Ventricular
aneurysm: .........................................................................
............................................................ 12
- Hallmark ECG findings: persistent ST segment elevation after recent MI and deep
Q waves in same
leads..............................................................................
...................................................................................
12
- Large VA: can lead to progressive left ventricular enlargement leading to heart
failure, refractory
angina, ventricular arrhythmia and mural thrombus leading to systemic
embolization ................................ 13
- Progressive LV enlargement can lead to
MR ................................................................................
........... 13
- Confirmed with echo�showing dyskinetic wall motion of a portion of left
ventricle ........................... 13
Papillary muscle
rupture: ..........................................................................
.......