4. Cardiopathie ischémique ''stable'' Flashcards
Classical chest pain sx (3)
- DRS aka chest pain (discomfort, heaviness, aching, pressure; NOT changing in intensity with inspiration (PAS PLEURÉTIQUE) cough or position change; with or without radiation into jaw, neck, shoulders, arms)
- Provoked by exertion or emotional stress
- Relieved within <5 min by rest or Nitroglycerin.
Atypical chest pain sx (5)
Non-classical symptoms might include:
SOB(OE),
N/V,
diaphoresis,
fatigue,
dizziness
Atypical chest pain sx occur in which populations
DM, women, patients without risk factors (eg. young)
Risk Factors modifiable (9)
Smoking
DLP
DM2
CKD
HTN
Obesity or Metabolic syndrome
Physical Inactivity
Diet
Depression
Risk Factors NON modifiable (4)
Age
Sex (male)
Ethnicity (Hispanic, Native American, African American, Asian)
Family history of premature CVD (1st degree relative, <55yo men, <65yo women)
Common cardio-vascular co-mordibities
Valvular disease
Cerebrovascular disease
Peripheral vascular disease
Renal disease
Findings consistent with CAD include on
12-Lead ECG (5)
Evidence of left ventricular hypertrophy
ST-T wave changes consistent with ischemia
Previous Q-wave myocardial infarction (MI)
Bundle branch block
Conduction/rhythm disturbances
Investigations - stable pt en bureau
Hemoglobin
Full lipid panel (Total cholesterol, LDL, HDL)
Fasting blood glucose or HbA1c
Creatinine
AST, ALT, Total Bilirubin
TSH
when to do a non invasing testins
1-3 sx + risk factors
Choice of non-invasive testing
Exercise ECG (tapis)
vasodilators (adenosine, dipyridamole, regadenoson)
and cardiac stimulants (dobutamine)
when is Invasive testing indicated
High pretest probability of stable ischemic heart disease
High-risk features on non-invasive testing
Persistent symptoms or inadequate QOL despite optimal medical treatment
History of ACS
Life-threatening arrhythmias
Management of Stable Disease (general approach)
- rx adherence
- lifestyle (smoking, weight loss, diet, physical activity)
- treat DM, DLP, HTN
- manage stress and depression
- know red flags when to seek medical care
Rx/tx that improve prognosis
- ASA 81mg (or Clopidogrel 75mg if ASA intolerance)
- High-intensity Statin
- ACEI (or ARB)
- Revascularization therapy (PCI or CABG) in patients who underwent coronary angiography
when are ACEI (or ARB) indicated
HTN, DM2, CKD, LVEF ≤ 40%
examples of high intensity statisn
Rosuvastin 20-40mg daily, Atorvastatin 80mg daily
sx relief
- Nitroglycerin (short-acting) 0.4mg SL tab or spray q5 mins PRN
- Beta-blockers
- Nitro patch
Nitroglycerin dose short acting and when to seek medical attention
0.4mg SL tab or spray q5 mins x3 PRN
seek prompt medical attention if pain persists after 3 doses
bb indication
MI, HF, LVEF ≤ 40%,
bb example
Bisoprolol
HR target with bb
55-60bpm
Example of dihydropyridines CCB
amlodipine = norvasc = long acting
nifedipine = adalat = fast acting
Example of non-dihydropyridines
diltiazem aka Cardizem (usually preferred)
verapamil (isoptin)
Nifedipine pharK (onset of action, peak effect, duration of effect
Rapid onset of action (buccal, 10-15 minutes; oral, 30-45 minutes)
peak effect (buccal, 30 minutes, oral, 60 minutes)
The duration of effects is four to six hours
mean arterial pressure reduction of 21.6%
avoid bb with
non-dihydropyridine CCB
aka
diltiazem aka Cardizem
verapamil (isoptin)
