Angina Flashcards
Causes
Caused by coronary artery disease
Presents with chest pain and/or tightness
Stable Angina
Predictable
Presenting with consistent amount of exertion
The patient can achieve relief with rest or nitroglycerin
Indicative of a stable, flow-limiting plaque
Unstable Angina
Defined as any new angina or rapidly worsening stable angina
Unpredictable
Often presenting during periods of inactivity such as sitting and watching television
Limited improvement with nitroglycerin and usually recurs soon afterward
Indicative of a ruptured plaque with subsequent clot-formation in the vessel
Symptoms
Chest Pain
Precipitated by exertion
relived by rest or nitrates
radiates to arms, jaws and/ neck
may include diaphoresis, nausea and lightheadedness
classic symptoms do not always present in the elderly, women, and diabetics
Physical Exam
Generally unremarkable
might identify bruits and hypertension on evaluation
Evaluation
EKG may demonstrate
ST-segment depression
ST-segment elevation
T wave inversion
Q waves
Labs
May have elevated cardiac enzymes (troponin, CK, CK-MB)
Evaluate risks via exercise stress test or catheterization
Differential
MI, PE, angina, variant/Prinzmetal’s angina, thoracic aortic aneurysm, esophageal rupture, pancreatitis, pseudocyst, neoplasms, orthopedic causes of back pain, appendicitis, and gallbladder disease, GERD
Treatment
Treat acute symptoms morphine
oxygen
nitroglycerin
aspirin
ACEIs
beta-blockers
Admit to CCU to rule-out MI
3 sets of cardiac enzymes (or 2 sets spaced 12 hours apart)
Heparinization and angiography/angioplasty in patients with EKG changes or worsening symptoms
Calcium channel blocker (nifedipine) for chronic management of unstable angina
CABG indicated in cases of failure of medical therapy, three-vessel disease, or two-vessel disease in diabetics
Discharge home if pain decreases; negative EKG and enzymes; focus on risk factor reduction (i.e. diet, exercise, BP control, cholesterol control, smoking)
Prognosis
Must control diabetes considered a CAD equivalent causing
MI to often present atypically in these patients
Manage hypertension (<140/90 mmHg)
Manage cholesterol levels (<70 mg/dL)
Encourage smoking cessation and alcohol abstention
Prevention
MI prevention with Aspirin or clopidogrel (for ASA sensitivities)
Angina prevention with β-blockers to lower HR , increase myocardial perfusion time and decrease cardiac work load
Nitrates + calcium channel blockers in severe or recurring cases
