Angina Flashcards

1
Q

Angina

A

Decreased blood flow through the vessel = tissue ischemia

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2
Q

Stable Angina

A

Classic or chronic:

Exertional ( most common)

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3
Q

Prinzmetal’s angina

A

Variant/vasospastic ( studded influx of calcium intracellular) 3%
Occurs at various times, including rest

Tx CCB
EKG may show ST elevation

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4
Q

Unstable Angina

A

Pre-infarction, rest or crescendo, coronary syndromes

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5
Q

Micro vascular Angina

A

Metabolic syndrome

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6
Q

Angina signs/symptoms

A

Characteristic chest discomfort lasting several minutes
Exertional is usually precipitated by physical activity; subside with rest
Nitroglycerin shortens or prevents attacks

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7
Q

Angina physical exam findings

A

May see signs of peripheral Arterial disease
Levine’s sign = “clenched fist sign”
Transient S4 not uncommon during angina

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8
Q

Angina Lab/Diagnostic

A

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

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9
Q

Cholesterol Levels

A

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

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10
Q

Angina Management

A

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

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11
Q

10 year atherosclerotic cardiovascular disease risk (ASCVD)

A
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
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12
Q

Individuals who may benefit from statin therapy

A

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

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13
Q

High Intensity Statin Therapy

A

Daily dose lowers LDL on average , by > 50%

Atorvastatin 40-80mg
Rosuvastatin 20-40mg

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14
Q

Moderate Intensity Statin Therapy

A
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
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15
Q

Low Intensity Statin Therapy

A

Daily dose lowers LDL on average, by <30%

Simvastatin 10mg
Pravastatin 10-20mg
Lovastatin 20mg
Fluvastatin 20-40mg
Pitavastatin 1mg
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16
Q

Common agents other than statins

A

Bile acid sequestrants: mostly decrease LDL; may increase TG
Cholestyramine (questran)
Colesevelem (Welchol)
Colestipol (Colestid)

Fibrates: decrease TG, slightly decrease LDL and possible increase HDL
Gemfibrozil (Lopid)
Fenofibrate (Tricor)
Fenofibric Acid (Trilipix)

Cholesterol absorption inhibitors: Used in combo with a statin to decrease LDL
Ezetimibe (zeta)

Niacin: decrease LDL and TG and increase HDL
“Flushing”