|
 | Presentation
 | Chest pain at rest or with minimal exertion |
| Recent onset, <30 minutes duration, relieved with sublingual nitro
 | (MI is pain > 30 mins, not relieved with sublingual
nitro) |
|
| Increased severity, duration, or frequency of chronic angina |
| SOB, N/V, diaphoresis, radiation to shoulders/jaw |
|
| History
| Describe pain and associated sxs |
| R/O contraindications to lytic tx (bleeding, trauma, CVA, recent
surgery) |
| PMH: DM, HTN, hyperlipidemia |
| SH: smoking, EtOH, diet, exercise |
| FH: heart dz, CVA, DM |
|
| PE
| HEENT: fundoscopic exam for vessel changes |
| CV: all pulses, heart exam, JVD, bruits
| Increased JVD, S4 |
| New-onset mitral regurgitation |
|
| Resp: auscultate |
| Abd: bruits |
| Extremities: pulses, edema |
|
| DDx
| Cardiac: Unstable angina, Prinzmetal's angina, AMI |
| Pulmonary: PE, pnuemonia |
| GI: PUD, GERD, esophageal spasm, acute cholecystitis |
| MS: Musculoskeletal chest pain |
|
| Laboratory
| EKG x 3, cardiac enzymes x 3, CXR (ST changes, new-onset LBBB) |
| CBC w/ diff, coags, BMP |
| UA, monitor I/O, pulse oximetry |
|
| Treatment
| Admit to ICU/telemetry |
| Drugs
| ASA or (G IIa IIIb inhibitor?) |
| Nitro drip |
| Oxygen |
| Beta blocker (esp. if tachycardic) |
| ACE inhibitor |
| Heparin (or thrombilytics in the first six hours) |
|
| Cardiac cath (when medically stable?) |
| V-tach? Give amiodarone. Shock if BP lowers. |
| V-fib? Make sure all leads are attached, give precordial thump, DCCV. |
| Heart block? Give atropine if bradycardic. |
|
| Miscellaneous
| Inferior MI (II, III, aVF)
| Bradycardia |
| Hypotension |
|
| Anterior MI (I, aVL, precordial leads)
|
|
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