angina Flashcards
what are the three types of arterial disease
artherosclerosis (large/medium)
monckberg (medium)
arteriosclerosis (small)
dystrophic calcification is associated with which kind of arterial disease
monckerberg arteriosclerosis: media classically involved
which layer is affected in monckeberg?
media. lumen unaffected
which layer affected in artherosclerosis
intima, cholesterol plaque within vessel walls
causes of artherosclerosis
smoking, diabetes, HTN, dyslipidemia, age
What happens to the artery when its damaged?
platelets binds to the subendothelium and releases PDGF and cytokine: monocyte adhesion and macrophage stays activated in vessel intima (and eats the lipids)= foam cell
smooth muscle also digests the fat. (PDGF recruits this step)
many foam cells= fatty streak
foam cells fibrous cap formation (plaque)–>complex atheroma (calcification)
in atheroma formation _____ also proliferate and deposit extracellular matrix by secreting collagen and other fibrous materials.
smooth muscle cells
What are the two forms of arteriosclerosis
hyaline: pink amorphous material on H & E staining
hyperplastic: onion skin appearance
What are the factors involved in smooth muscle cell recruitment?
PDGF
FGF
Endothelin-1
Interleukin-1
Whats the difference between stable and unstable plaque?
Fibrous cap determines plaque stability.
progressive, decreased coronary blood flow and increased VEGF- what kind of plaque
stable
chronic inflammation, macrophage activation, metalloprotienases break down the extracellular matrix protiens–>thin cap fibroatheromas. risk of rupture–>thrombus formed over plaque, acute coronary syndrome. what type of plaque?
unstable plaque. no collateral circulation
atherosclerotic plaque stability is not related to which factors
plaque size or luminal narrowing
only related to fibrous cap
What are the types of coronary artery disease
angina
acute coronary syndrome
-unstable angina, NSTEMI, STEMI
What are the three criteria of angina
retrosternal chest pain
worse with exertion
improved with rest or nitroglycerin
angina presents with ___% of stenosis
> 70% of stenosis, without tissue infarction
In stable angina, what are the ECG changes and cardiac enzymes?
ECG–> no ST changes
cardiac enzymes-> not significantly elevated
retrosternal radiating non pleurtic non reproducible to palpation
stable angina
Why are dipyridamole and adenosine used to stress test the heart?
vasodilators, increase the HR (reflex tachycardia)
what do you give for stable angina (medical management)
antianginal therapy (nirates)
antiplatelet (asprin, clopidogrel)–> decrease risk of occlusive thrombus formation
statin therapy–> atorvastatin: decrease risk of acute coronary events
antihypertensive –> ACE inhibitor, ARB.
What is vasospastic angina
transient coronary vasospasm
presentation of vasospastic angina
younger patient, smoking, cocaine, triptans***, alcohol.
recurrent chest pain, occuring at night, but not affected by exertion.
ecg during vasospastic angina
ST elevation during an episode
treatment for vasospastic angina
symptomatic: nitroglycerin
preventative: calcium channel blockers
Which situation do you avoid nitrates?
right venticular MI
What cardiac drugs do you avoid in the AV block?
B blockers and Calcium channel blockers
