33 Angina

Question 1

chronic stable angina

Answer 1

chronic stable chest pain when demand for myocardial O2 exceeds the ability of the coronary arteries to supply heart

Question 2

for ischemia to occur from an atherosclerotic plaque, the artery is usually stenosed (blocked) by ___%

Answer 2

70% or more

Question 3

pain at rest is unusual

Answer 3

may indicate UA

Question 4

ST depression is significant if…

Answer 4

at least 1mm below the isoelectric line in at least 2 contiguous leads

Question 5

when pain is relieved, ECG…

Answer 5

returns to normal

Question 6

silent ischemia

Answer 6

ischemia that occurs in the absence of any subjective symptoms

• common in diabetic pt due to neuropathy
• ECG changes are present (ST depression)

Question 7

chronic stable angina may progress or develop into…

Answer 7

UA or ACS

Question 8

goal of Tx for pt admitted w angina

Answer 8

decr O2 demand + incr O2 supply

Question 9

if pt has angina, perform the following measures…

Answer 9

1 upright position + provide O2
2 assess VS
3 ECG monitor
4 obtain 12 lead ECG
5 pain relief w NTG thenIV opioid
6 obtain cardiac biomarkers
7 asess hrt + breath sounds
8 chest x ray

Question 10

first line tx for acute angina

Answer 10

short-acting nitrates

Question 11

nitrates MOA

Answer 11

1 dilate perph blood for decr blood return to heart> decr preload> decr work
2 dilate coronary arteries> incr blood flow to heart

Question 12

sublingual nitrate is a type of….

Answer 12

short acting nitrate

Question 13

sublingual nitrate onset

Answer 13

• relives pain in about 5 mins
• lasts 30-40 min
• given Q5mins for max dose of 3

Question 14

nitrate s/e

Answer 14

• headache
• dizzy
• flusing
• hypotension

Question 15

nitrates is CI if…

Answer 15

low BP

-sidenafil

Question 16

chronic stable angina drug therapy

Answer 16

• antiplatelet
• ace inhibitors, arbs
• B BLOCKERS
• Ca blockers
• lipid lowering
• nitrates

Question 17

heparin

Answer 17

prevents conversion of fibrinogen to fibrin + prothrombin to thrombin

Question 18

vitamin k antagonist

Answer 18

warfarin

Question 19

warfarin

Answer 19

interferes w hepatic synth of vit K dependent clotting factors

Question 20

thrombolytic agents

Answer 20

reteplace, alteplase, tenecteplase

-used only w ST elevation MI

Question 21

___ are usually given prophylactically for PCI

Answer 21

heparin or glycoprotein inhibitor to prevent clotting w/in stent

Question 22

After PCI, a patient usually receives… for minimum of 12 months

Answer 22

dual antiplatelet therapy (aspirin, ticagrelow, clopidogrel) until intimal lining grows over stent

Question 23

is acute coronary syndrome stemi or nstemi?

Answer 23

nstemi