4. Stable Ischemic Heart Disease Flashcards
What is the global leading cause of death?
Cardiovascular disease
Only ___% of coronary attacks are preceded by angina.
18%
What is variant angina?
angina at rest that occurs in cycles
What causes variant angina?
vasospasms
Varient angina is caused by blockage from a plaque. (T/F)
False
In variant angina, symptoms occur at rest. (T/F)
True
In varient angina, symptoms occur in clusters. (T/F)
True
What 2 medications does variant angina typically respond to?
- nitrates
- CCBs
What is the most effective treatment for variant angina?
CCBs
Nitrates can be used in addition to CCBs or alone to treat variant angina. (T/F)
True
Discomfort in the chest or adjacent areas caused by myocardial ischemia.
- angina pectoris
- chronic stable angina
Angina occurs when?
myocardial oxygen demand exceeds supply
What 4 factors play a role in myocardial oxygen demand?
- HR
- SBP
- myocardial wall tension
- myocardial contractility
What 5 factors play a role in myocardial oxygen supply?
- coronary blood flow
- coronary diameter and tone
- perfusion pressure
- HR
- oxygen extraction and content in blood
Angina is brought on by the 4 E’s. What are the 4 E’s?
- exercise
- emotional stress
- eating a heavy meal
- exposure to hot/cold weather
What 2 things relieve angina pain?
- rest
- nitroglycerin
Describe angina pain.
- pressure and tightness
- pain radiates from the chest to the neck, jaw, left shoulder, and arm
Most patients experiencing angina do not feel the classic symptoms. (T/F)
True
What types of patients may not feel chest pain? (5)
- diabetics
- elderly
- cardiac transplant
- post surgical or recent pain mediations
- pain perception is altered by neuropathy
Describe atypical angina chest pain.
- pleuritic, sharp, knife-like, choking
- involves chest wall
- highly variable radiation patterns
- random onset
- lasts any duration of time
- variable response to nitroglycerin
What are some other cardiac causes of chest pain that are not angina? (3)
- aortic dissection
- aortic stenosis
- pericarditis/ myocarditis
What are some non-cardiac causes of chest pain that are not angina? (7)
- GERD
- anemia
- pulmonary embolism
- pneumonia
- anxiety
- rheumatic disease
- shingles
Chest pain is a specific symptom that points to a diagnosis. (T/F)
False: non specific
Chest pain always indicates a serious issue. (T/F)
False: mild - life threatening
What should you do if a patients comes to you complaining of chest pain?
Send them to the ED or physician as soon as possible
What should the diagnostic process always begin with?
history and physical
What are the important characteristics of chest pain that you should ask the patient about? (6)
- time
- place
- quality
- quantity
- provocative/ palliative factors
- associated symptoms
What are the diagnostic tests that may be performed on a patient complaining of chest pain? (5)
- EKG
- stress testing
- imaging
- echocardiography
- cardiac catheterization
What are the short term treatment goals for angina?
reduce or prevent limiting symptoms
What are the long term treatment goals for angina?
prevention development of other CVD
What are some CVDs that angina can develop into?
- myocardial infarction
- arrhythmias
- heart failure
- decrease mortality
What are the 4 steps to approach treatment of patient with stable angina?
- Identify and treat precipitating factors
- Risk factor modification
- Manage symptoms
- Perform revascularization if indicated
What are the 2 revascularization procedures?
- percutaneous coronary intervention (PCI)
- coronary artery bypass graft (CABG)
What is primary prevention of angina?
Identifying risk for heart disease and modifying risk which can be influenced.
What are some non-modifiable risks of heart disease? (4)
- gender ( male > female)
- age
- family history
- environment
Which gender is more susceptible to heart disease?
men
What are some modifiable risks for heart disease? (7)
- smoking
- HTN
- hyperlipidemia
- obesity
- glucose control
- stress
- sedentary lifestyle
What are the 3 main goals of secondary prevention of angina?
- identifying
- treating
- rehabilitating
What modifiable risk factor has been shown to increase the risk of CHD by 2-3x?
smoking
Why does smoking cause CHD? (3)
- causes oxidative stress which leads to endothelial dysfunction
- decreases oxygen carrying capacity
- lowers HDL
How long does it take a previous smoker’s CVD risk to decline to that of a non-smoker?
1 year
What are the first line pharmacological agents for smoking cessation? (3)
- nicotine replacement
- bupropion (Zyban, Wellbutrin)
- varenicline (Chantix)
What are the programs designed to help smokers quit? (3)
- Cooper-Clayton Method
- 5 A’s
- Quit Now
What are pharmacological preventative/ treatment therapy options for angina? (3)
- ASA
- clopidogrel (Plavix)
- Statins
What are pharmacological symptomatic treatment options for angina?
- β blockers
- CCBs
- nitrates
- ranolazine (Ranexa)
What are the 2 different methods of PCI?
- balloon angioplasty
- coronary stenting
Several clinical trials have shown medical therapy to be inferior to PCI. (T/F)
False: equally efficacious and safe
What is a CABG procedure?
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.
In what patients is CABG indicated? (3)
- multivessel disease with LV dysfunction
- significant disease of major coronary vessels
- shows benefit in diabetic patients
