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AHN 568 Questions and Answers
2024/2025
angina pectoris
occurs in adults. achy, dull, tight, severe, pressing, not usually sharp or substernal.
women more likely to have atypical symptoms. exertion, cold exposure, emotional
stress aggravate. nitro, rest, and valsalva alleviate. present with sinus tach, brady, or
apical systolic bulge coincident with pain, xanthomas, signs of heart failure. Diagnose
with ECG, coronary arteriography, radionuclide tests, stress test.
Variant angina (Prinzmetal's angina)
occurs in adults. achy, dull, tight, severe, pressing, not usually sharp or sticking
substernal. often occurs at rest or at night. nitro and rest help. diagnose with ECG
during attack, cornoary arteriography.
GERD (gastroesophageal reflux disease)
Any age. Burning, tightness, may be identical to angina. water brash "heartburn".
aggravated by overeating, recumbency, occasionally exertion. antacids and PPIs help.
diagnose esophagoscopy, ambulatory monitoring of pH, short course PPI
Esophageal spasm
Obese patients. Identical pain to angina. often induced by ingestion of alcohol or cold
liquids. occasionally relieved by nitro. diagnose with esophageal manometry.
mitral valve prolapse
Any age. not usually substernal. often sticking quality and may last several hours.
Palpitations, arrhythmias, often occurs at rest, syncope. Beta blockers and recumbency.
Click/late systolic murmur. diagnose with echocardiogram, phonocardiogram.
hypertrophic cardiomyopathy
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Any age. pain similar to angina. dyspnea, arrhythmias, and lightheadedness. nitro
might aggravate pain. betablockers and squatting help. physical findings of murmur
intensified by nitro and valsalva maneuver but decreased by squatting. Diagnose with
echo.
Intercostal myositis
Any age more common in kids and athletes. sticking quality pain. intensify with
inspiration. localized tenderness on palpation. no pleural friction.
costochondritis
aggravated by severe coughing. "splinting" of area helps.
Cervicodorsal arthritis
Adults. sharp or sticking pain lasting a few seconds. precipitated by certain
movements of neck and twisting, not related to stress. diagnose radiographs of
cervicodorsal spine.
pulmonary embolism
Usually adult. Sharp, severe, often pleuritic pain. associated with tachypnea and
hemoptysis. precipitated by prolonged immobilization, oral contraceptives especially
in smokers. Findings of DVT, tachypnea, minimal cyanosis. Diagnose with sprial CT, D-
dimer assay, V/Q scan, pulmonary angiography.
Pneumonia
associated with fever and cough. findings of egophony, dullness on percussion
chest wall syndrome
adults more common in athletes. pain often sharp and sticking, fleeting. aggravated
by recumbency and certain positions. local tenderness on palpation "crowing rooster"
maneuver may precipitate pain.
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