CC Sept 2015 Chest pain in women

echoecho's version from 2015-10-13 02:23


Question Answer
The age-adjusted death rate from cardiovascular disease has decreased by ____ since 1980 due to public awareness, prevention and treatment of cardiovascular disease of women in the US?1/3
The precentage of the general public that knows that cardiovascular disease is the number one killer of women almost ______ (tripled vs. doubled) from 1997 to 2009?doubled
More women die from cardiovascular disease in the US than from 4 conditions combined?cancer, COPD, dementia, accidents
Increasing rates of ______ may temper or negate the gains made on other preventive measures such as tobacco abuse?obesity
LisHt the traditional presenting symptoms of ACS (acute coronary syndrome)?chest pain (or pressure or tightness), diaphoresis, nausea, radiation of pain to the arm, jaw or shoulder.
Can symptoms of ACS be reproduced with exercise? relieved with NTG?yes; yes
List the risk factors for ACS?previously diagnosed atherosclerotic CAD, HTN, DM, tobacco abuse, fm hx of early coronary arter disease and dyslipidemia.
Impaired _____ function might also be a predictor for ACS in women?renal
List the 5 validated clinical decision rule to predict CAD in woemn with chest pain?1) women > 65 y.o. (1 point) 2) known vascular disease (including CAD, PVD, or cerebrovascular disease) (1 point) 3) pain worse with exercise (1 point) 4) pain not elicited with palpation (1 point) 5) pt thinks that the chest pain is cardiac in origin (1 point)
Give the positive likelihood ratios for 4-5 points; for 2-3 points; for 0-1 points?4.52; 1.83; 1.09
Traditional symptoms of ACS were compared between men and women in a sample of 688 pts presenting to ER with s/s suggestive of ACS (the sample was 38% female and 69% white with a median age of 59 y.o. The sensitivity of many of the classical s/s were similar (name these with % women vs. % men)?1. chest discomfort (67% women vs. 75% men) 2) chest pain (70% women vs. 77%) 3) chest pressure (68% women vs. 69% men)
*** What symptom was a more sensitive predictor of ACS in women than in men? Give %?shortness of breath; 61% women vs. 46% men
Are the "traditional" symptoms associated with ACS less common in women?yes
What are women with ischemic chest pain more likely than men to report in way of symptoms?1) inframammary pain 2) palpitations 3) pain described as sharp or stabbing
Because pain thresholds vary, what do women often describe the pain compared to males?women report pain that is less acute and of lesser severity than males
In a systematic review of 69 studies done in 2007, women ultimately diagnosed with ACS were more likely to present without chest pain than men (give the %)? Comment on what lessened the difference between female and males?38% of women vs. 27% of men (the difference lessened as the women aged)
*** In a 2012 observational study of nearly 500,000 women and more than 600,000 men diagnosed with MI, the proportion of women presenting without chest pain was greater than in men as was the ________ (morbidity vs mortality)? This difference also lessened with increasing ____?mortality; age
What is the recommendations for initial work-up of suspected ACS (does not differ between genders)?1) 12-lead EKG while a focused hx and PE is performed 2) labs like serum troponin (the preferred biomarker to asses myocardial damage in both men and women) 3) receive 325 mg ASA (unless allergic), oxygen, NTG and/or morphine for pain control 4) pts with EKG evidence of acute infarct shoulder receive urgent percutaneous coronary intervention 5) all pts w/ unstable angina or suspected non-ST segment elevation MI benefit from urgent cardiology consultation and antithrombotic therapy and close monitoring of symptoms and biomarkers 6) pts with non-diagnostic EKG who become pain free should be monitored with serial biomarkers 7) if these pts do not develop evidence of ACS, assessment of underlying CAD is warranted
Women who are at intermediate risk for underlying CAD should undergo what type of testing?noninvasive
Women at low risk should undergo what type of testing?none as they will not benefit from testing
Women at high risk should under go what type of testing?coronary angiography
Why are ore expensive modalities such as GXT (graded exercise stress test) with myocardial perfusion imaging (MPI) (sensitivity 90%, specificity 70%) used these days?because of the limited diagnostic accuracy (sensitivity 31%, specificity 52-74%) of a graded exercise stress test (GXT) for evaluating women with chest pain for cardiovascular disease
In a study of 1000 women presenting with chest pain (avg age 54 y.o.) who underwent GXT for chest pain, ____% of all women achieved a diagnostic sutdy as defined as reaching > 85% of their maximum predicted heart rate (defined as 220-age)?96%
Women who had low functional capacity on the GXT (non-diagnostic study, a low Duke Treadmill Score or low metabolic equivalents reached) had increased risk of cardiovascular _______ and _______ over the 6 year study?mortality; morbidity
*** This suggests that the non-EKG portions of the GXT may be able to enhance the ability of GXT to do what?to predict adverse outcomes
Patients w/ low functional capacity need further evaluation with what modalities?MPI (myocardial perfusion imagining) or stress echocardiogram