4. Angina and PAD Flashcards
Stable angina cause
Heart O2 consumption exceeds supply
Atherosclerosis most common cause
Stable angina risk factors
Age
Male
White
Smoking, high lipids, HTN, DM, ASCVD, FH
Stable angina symptoms
Chest discomfort/pressure with exertion/eating
Stable angina signs
Levine sign
Otherwise often none when no exertion/eating
Stable angina diagnostics
CCTA = GOLD STANDARD
Stress testing
Coronary artery calcium scan
Stable angina treatment
Lifestyle
Beta blockers
Nitros PRN
Aspirin (clopidogrel if allergic)
High intensity statin (atorvastatin, rosuvastatin)
ACE/ARB if DM, CKD, HTN, or EF <40%
Define terms:
Angina
Unstable angina
Stable angina
Typical angina
Atypical angina
Angina = chest discomfort due to lack of blood to heart
Unstable angina = angina with no clear pattern or trigger
Stable angina = predictable angina with known trigger
Typical angina = chest/arm/jaw discomfort/pressure
Atypical angina = Epigastric/back/indigestion-like discomfort
Unstable angina cause
Angina with no clear pattern or cause, occurs at rest
Impending MI
Compare and contrast unstable angina and vasospastic/prinzmetal angina
Unstable angina:
>15 min with abnormal diagnostics
Vasospastic/prinzmetal angina:
<15 min, no lingering dx abnormalities
Both can occur at rest
Myocardial infarction cause
Necrosis of heart tissue due to ischemia
MI risk factors
Same as stable angina
Age
Male
White
(Smoking, high lipids, HTN, DM, obesity, ASCVD, FH)
MI symptoms
DYSPNEA
Heaviness/pressure/tightness in chest
Sweating
Elderly may only have dyspnea, dizziness, or arrythmia
MI signs
Dyskinetic apical pulsation on palpation
Rales = CHF
MI diagnostics
BEST TEST = high sensitivity TROPONINS (T & I)
Also EKG ASAP
STEMI:
ST elevation
New LBBB
NSTEMI:
ST depression
T-wave inversion
MI treatment
Admit all patients with suspected acute MI
BONAS to restore O2:
Beta-blockers
Oxygen >90%
Nitroglycerin
Aspirin
Statin
STEMI = BONAS + PCI = percutaneous coronary intervention (reperfusion)
OR
BONAS + thrombolytics if no bleed risk
NSTEMI = NO THROMBOLYTICS
Post-MI complications
MOST COMMON = V Fib
V Tach
A Fib
Mitral regurge
Ventricular septal defects
Myocardial rupture
Stroke
Peripheral atherosclerosis cause
Atherosclerosis of peripheral arteries
Most common location of peripheral atherosclerosis is …
Femoropopliteal artery
Peripheral atherosclerosis risk factors
MOST OFTEN AGE 60-70
HYPERHOMOCYSTEINEMIA (amino acid buildup damages vessel walls)
Smoking
DM
High lipids
HTN
Family history
Peripheral atherosclerosis symptoms
INTERMITTENT CLAUDICATION
Resolves with rest (like stable angina for the legs)
If pain at rest, this is bad!
Rest pain = worse with elevation, better with dangling off the bed
Peripheral atherosclerosis signs
DESCREASED LEG PULSES
BUERGER TEST = elevate leg and see what happens (color change = bad!)
Ulceration, necrosis, gangrene
Ischemia = hair loss, cool, pallor
Check for sensory and motor loss
Peripheral atherosclerosis diagnosis
Ankle-brachial index low (<0.9?)
Ultrasound = best in real life
Peripheral atherosclerosis treatment
Stop smoking
Aspirin
Supervised exercise
- if exercise doesn’t help then give cilostazol or naftiorofuryl (vasodilators)
Lower lipids and BP
Treat DM
Surgery can help
Acute arterial occlusion cause
MOST COMMON = CARDIAC EMBOLISM
(From LAA)
Acute arterial embolism risk factor
A Fib
Acute arterial occlusion symptoms
SUDDEN sever limb pain
Muscle weakness
Parasthesia
Acute arterial occlusion signs
Loss of pulses
Cool skin
Acute arterial occlusion diagnostics
Angiography with dye
Acute arterial occlusion treatment
URGENT revascularization (within 3 hours)
This is an emergency!
Another name for atheroembolism is …
Cholesterol crystal embolism
Atheroembolism cause
Friable (fragile) aortic plaque embolizes causing a CHOLESTEROL CRYSTAL SHOWER STORM
Atheroembolism risk factors
Invasive testing
Trauma
Atheroembolism symptoms/signs
ALL SHOW UP AT SAME TIME
Transient ischemic attacks
Renal failure
Skin changes (levido reticularis, blue toes)
Atheroembolism diagnosis
TEE - looking for original plaque
Atheroembolism treatment
Blockages too small to operate on
Aspirin, statin, HTN meds, treat DM, stop smoking
Thromboangiitis obliterans other name
Buerger’s disease
Thromboangiitis obliterans cause
Blood vessels in ARM blocked by INFLAMMATION
Both arterial and venous!
Thromboangiitis obliterans risk factors
Men age 40-50 who smoke anything
Thromboangiitis obliterans symptoms
Claudication, rest pain, ulcers in ARMS
Thromboangiitis obliterans treatment
Stop smoking!
Otherwise amputation
Raynaud’s phenomenon cause
Episodic vasospastic ischemia of digits in response to cold
Maybe autoimmune
Raynaud’s phenomenon risk factor
Women
Raynaud’s phenomenon symptoms
Digital blanching > cyanosis > rubor
Raynaud’s phenomenon treatment
Gloves, avoid cold
Live with it
If not:
Nifedipine
Prazosin
