Angina Flashcards
Angina
Decreased blood flow through the vessel = tissue ischemia
Stable Angina
Classic or chronic:
Exertional ( most common)
Prinzmetal’s angina
Variant/vasospastic ( studded influx of calcium intracellular) 3%
Occurs at various times, including rest
Tx CCB
EKG may show ST elevation
Unstable Angina
Pre-infarction, rest or crescendo, coronary syndromes
Micro vascular Angina
Metabolic syndrome
Angina signs/symptoms
Characteristic chest discomfort lasting several minutes
Exertional is usually precipitated by physical activity; subside with rest
Nitroglycerin shortens or prevents attacks
Angina physical exam findings
May see signs of peripheral Arterial disease
Levine’s sign = “clenched fist sign”
Transient S4 not uncommon during angina
Angina Lab/Diagnostic
EKG may be normal, with down sloping ST segment, or T wave peak or inversion during attack
Exercise EKG
Lipid Panel
Coronary angiography is the definitive diagnostic procedure but not indicated solely for diagnosis
Cholesterol Levels
Total: Desirable: <200
VLDLs Triglycerides: Normal = < 150
LDL: optimal: <100
HDL: low <4 High >60
Goals for DM or CAD
LDL <70
HDL >40
TG <150
Angina Management
Reduction of risk factors when possible
Managed diet: Decrease saturated fats, then decrease unsaturated fats, and then consider plant sterols
Low dose enteric-coated aspirin 81 mg daily
Common pharmacotherapy for angina:
Nitrates
Beta blockers
Calcium channel blockers
Optimizing lipid panel values
Estimate 10 year arthro-sclerotic cardiovascular disease risk
Identify individuals who may benefit from statin therapy
10 year atherosclerotic cardiovascular disease risk (ASCVD)
Defined as the first occurrence of non-fatal and fatal M I and non-fatal and fatal stroke To identify candidates for statin therapy; estimated risk of a SCVD is based on: Age Sex Race Total cholesterol HDL Systolic blood pressure Diabetes status Smoking
Individuals who may benefit from statin therapy
Individuals with clinical evidence of ASCVD
Individuals with elevated LDL greater than or equal to 190
Diabetics 40–75 years of age with LDL between 70–1 89 but without clinical evidence of ASCVD
Individuals without ASCVD or diabetes with LDL between 70–1 89 but with an estimated 10 year risk ASCVD of 7.5% or higher
High Intensity Statin Therapy
Daily dose lowers LDL on average , by > 50%
Atorvastatin 40-80mg
Rosuvastatin 20-40mg
Moderate Intensity Statin Therapy
Daily dose lowers LDL on average, by approximately 30 to <50% Atorvastatin 10-20mg Rosuvastatin 5-10mg Simvastatin 20-40mg Pravastatin 40-80mg Lovastatin 40mg Fluvastatin 80mg Pitavastatin 2-4
Low Intensity Statin Therapy
Daily dose lowers LDL on average, by <30%
Simvastatin 10mg Pravastatin 10-20mg Lovastatin 20mg Fluvastatin 20-40mg Pitavastatin 1mg