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957 Block 3 > 4. Stable Ischemic Heart Disease > Flashcards

4. Stable Ischemic Heart Disease Flashcards

1
Q

What is the global leading cause of death?

A

Cardiovascular disease

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2
Q

Only ___% of coronary attacks are preceded by angina.

A

18%

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3
Q

What is variant angina?

A

angina at rest that occurs in cycles

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4
Q

What causes variant angina?

A

vasospasms

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5
Q

Varient angina is caused by blockage from a plaque. (T/F)

A

False

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6
Q

In variant angina, symptoms occur at rest. (T/F)

A

True

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7
Q

In varient angina, symptoms occur in clusters. (T/F)

A

True

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8
Q

What 2 medications does variant angina typically respond to?

A
  • nitrates

- CCBs

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9
Q

What is the most effective treatment for variant angina?

A

CCBs

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10
Q

Nitrates can be used in addition to CCBs or alone to treat variant angina. (T/F)

A

True

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11
Q

Discomfort in the chest or adjacent areas caused by myocardial ischemia.

A
  • angina pectoris

- chronic stable angina

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12
Q

Angina occurs when?

A

myocardial oxygen demand exceeds supply

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13
Q

What 4 factors play a role in myocardial oxygen demand?

A
  • HR
  • SBP
  • myocardial wall tension
  • myocardial contractility
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14
Q

What 5 factors play a role in myocardial oxygen supply?

A
  • coronary blood flow
  • coronary diameter and tone
  • perfusion pressure
  • HR
  • oxygen extraction and content in blood
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15
Q

Angina is brought on by the 4 E’s. What are the 4 E’s?

A
  • exercise
  • emotional stress
  • eating a heavy meal
  • exposure to hot/cold weather
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16
Q

What 2 things relieve angina pain?

A
  • rest

- nitroglycerin

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17
Q

Describe angina pain.

A
  • pressure and tightness

- pain radiates from the chest to the neck, jaw, left shoulder, and arm

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18
Q

Most patients experiencing angina do not feel the classic symptoms. (T/F)

A

True

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19
Q

What types of patients may not feel chest pain? (5)

A
  • diabetics
  • elderly
  • cardiac transplant
  • post surgical or recent pain mediations
  • pain perception is altered by neuropathy
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20
Q

Describe atypical angina chest pain.

A
  • pleuritic, sharp, knife-like, choking
  • involves chest wall
  • highly variable radiation patterns
  • random onset
  • lasts any duration of time
  • variable response to nitroglycerin
21
Q

What are some other cardiac causes of chest pain that are not angina? (3)

A
  • aortic dissection
  • aortic stenosis
  • pericarditis/ myocarditis
22
Q

What are some non-cardiac causes of chest pain that are not angina? (7)

A
  • GERD
  • anemia
  • pulmonary embolism
  • pneumonia
  • anxiety
  • rheumatic disease
  • shingles
23
Q

Chest pain is a specific symptom that points to a diagnosis. (T/F)

A

False: non specific

24
Q

Chest pain always indicates a serious issue. (T/F)

A

False: mild - life threatening

25
Q

What should you do if a patients comes to you complaining of chest pain?

A

Send them to the ED or physician as soon as possible

26
Q

What should the diagnostic process always begin with?

A

history and physical

27
Q

What are the important characteristics of chest pain that you should ask the patient about? (6)

A
  • time
  • place
  • quality
  • quantity
  • provocative/ palliative factors
  • associated symptoms
28
Q

What are the diagnostic tests that may be performed on a patient complaining of chest pain? (5)

A
  • EKG
  • stress testing
  • imaging
  • echocardiography
  • cardiac catheterization
29
Q

What are the short term treatment goals for angina?

A

reduce or prevent limiting symptoms

30
Q

What are the long term treatment goals for angina?

A

prevention development of other CVD

31
Q

What are some CVDs that angina can develop into?

A
  • myocardial infarction
  • arrhythmias
  • heart failure
  • decrease mortality
32
Q

What are the 4 steps to approach treatment of patient with stable angina?

A
  • Identify and treat precipitating factors
  • Risk factor modification
  • Manage symptoms
  • Perform revascularization if indicated
33
Q

What are the 2 revascularization procedures?

A
  • percutaneous coronary intervention (PCI)

- coronary artery bypass graft (CABG)

34
Q

What is primary prevention of angina?

A

Identifying risk for heart disease and modifying risk which can be influenced.

35
Q

What are some non-modifiable risks of heart disease? (4)

A
  • gender ( male > female)
  • age
  • family history
  • environment
36
Q

Which gender is more susceptible to heart disease?

A

men

37
Q

What are some modifiable risks for heart disease? (7)

A
  • smoking
  • HTN
  • hyperlipidemia
  • obesity
  • glucose control
  • stress
  • sedentary lifestyle
38
Q

What are the 3 main goals of secondary prevention of angina?

A
  • identifying
  • treating
  • rehabilitating
39
Q

What modifiable risk factor has been shown to increase the risk of CHD by 2-3x?

A

smoking

40
Q

Why does smoking cause CHD? (3)

A
  • causes oxidative stress which leads to endothelial dysfunction
  • decreases oxygen carrying capacity
  • lowers HDL
41
Q

How long does it take a previous smoker’s CVD risk to decline to that of a non-smoker?

A

1 year

42
Q

What are the first line pharmacological agents for smoking cessation? (3)

A
  • nicotine replacement
  • bupropion (Zyban, Wellbutrin)
  • varenicline (Chantix)
43
Q

What are the programs designed to help smokers quit? (3)

A
  • Cooper-Clayton Method
  • 5 A’s
  • Quit Now
44
Q

What are pharmacological preventative/ treatment therapy options for angina? (3)

A
  • ASA
  • clopidogrel (Plavix)
  • Statins
45
Q

What are pharmacological symptomatic treatment options for angina?

A
  • β blockers
  • CCBs
  • nitrates
  • ranolazine (Ranexa)
46
Q

What are the 2 different methods of PCI?

A
  • balloon angioplasty

- coronary stenting

47
Q

Several clinical trials have shown medical therapy to be inferior to PCI. (T/F)

A

False: equally efficacious and safe

48
Q

What is a CABG procedure?

A

A surgical procedure that uses veins from the leg or arteries from another part of the body to reroute around a blockage in the arteries that supply the heart with blood and oxygen.

49
Q

In what patients is CABG indicated? (3)

A
  • multivessel disease with LV dysfunction
  • significant disease of major coronary vessels
  • shows benefit in diabetic patients

957 Block 3 (6 decks)

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