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Medical Perspectives 411 > Angina > Flashcards

Angina Flashcards

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USMLE® Step 1 flashcards
1
Q

What is angina?

A

When the cardiac workload exceeds the oxygen supply to myocardial tissue, ischemia occurs which results in temporary chest pain or discomfort

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2
Q

Angina Pectoralis

A

chest pain

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3
Q

What is the imbalance between in angina?

A

imbalance between myocardial oxygen supply and deman

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4
Q

Reynauds

A

vasospasm of vessels due to increased epinephrine, SNS, and extrasensivity to Epineph

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5
Q

Angina all feel like

A

All causes central crushing chest pain or tightness radiating to arm, neck, and jaw

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6
Q

Stable angina duration

A

usually last less than 20 min

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7
Q

stable angina is unexpectantly caused by (precipitated)

A

exertion = increased workload

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8
Q

stable angina is relieved by?

A

rest or nitrates

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9
Q

Acute coronary syndrome (ACS) duration

A

Usually lasts more than 20 minutes

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10
Q

ACS is what?

A

sudden onset usually at rest and not relived by rest, have these patients walk to relief

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11
Q

stable and ACS angina associated with symptoms of what three aspects

A

decreased cardiac output
sympathetic activation
risk factors

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12
Q

Stable and ACS angina associated with sx of decreased Q

A

SOB
presyncope or syncope
cardiac palpitations

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13
Q

Stable and ACS associated with sx of sympathetic acitvation

A 
N
V
S
P
C
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14
Q

NVSPC stand for

A 
Nausea
Vomiting 
Sweating
Pale
Clammy
(same as MI sx)
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15
Q

Stable and ACS angina associated with sx of risk factors

A 
HTN
high cholesterol
DM
smoking
fam his
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16
Q

st segment is what for angina

A

depressed

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17
Q

there is a build up of what in angina?

A

lactic acid which increases acidity

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18
Q

sx of angina

A

chest pain and compression tightness felt

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19
Q

signs of angina

A

grabbing chest and breathing heavily

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20
Q

Angina examination

A

usually no signs ands symptoms w/ no change in change in asculation and percussions

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21
Q

angina examination signs of precipantants (causes)

A

anemia, infection, thyrotoxicosis, arrhythmias, risk factors, other artherosclerotic diseases (PVD, stroke), complications such as MR or CHF

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22
Q

Myocardial O2 supply and demand imbalance ekg myocardial ischemia

A

ST segment depression (changes)/ arythmias (supply)

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23
Q

Myocardial O2 supply and demand imbalance lactic acid build up

A

Lactic acid build up/wall motion abnormalities (contractile)

= myocardial ischemia via excess demand

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24
Q

Three types of anginal pain

A

Chronic Stable/classic/exertional angina
New-onset Angina
Nocturnal Angina/Tachycardia angina

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25
Q

Chronic Stable anginal pain defined

A

occurs at predictable levels of physical and/or emotional stress, so it occurs as same level of intensity of physical and emotional stress

26
Q

Chronic stable anginal pain responds to what?

A

promptly to rest or nitroglycerin; symptoms go away

27
Q

New-onset angina defined

A

Angina that has developed for the first time over the course of approx. 2 weeks, sometimes less, and is considered unstable because it is a medical emergency, not relieved with rest or nitrrates, and is a bad condition with heat (could be block or embolism)

28
Q

Nocturnal angina

A

same symptoms as exertional angina, but happens at night and wakes the individuals from sleep.
Could be from increased HR in dreams/ underlying CHF/ sleep apnea

29
Q

Stable angina treatment

A

statins, aspirin, ACEI, B-blockers, and nitrates

30
Q

Nitrates for stable angina do what?

A

sx relief or prophylaxis (patch or tablets but must have 8h nitrate free period/day

31
Q

Nitrates can be taken this way but for this reason it is not ?

A

orally destorys by 1st pass effect, enzymes break down this rapidly via enzyme induction

32
Q

Wholistic care (all IHD) treatment for nitrates

A

Lifestyle change- quit smoking, eat healthy, exercise more, avoid excessive exertion or stress
risk factor control- HTN, high cholesterol (keep <4mmol/ L), DM
assess depression and level of support

33
Q

Postinfarct angina

A

angina after an MI, residual ischemia zone due to infarction (chest pain for MI)

34
Q

Pre infarction angina

A

is unstable angina that is unpredictable

35
Q

preinfarct angina characterized by what

A

abrupt change in intensity (worsening), which direction better or worse

36
Q

Preinfarct angina increased

A

freq of sx

37
Q

preinfarct angina decreased

A

threshold of stimulus

38
Q

preinfarct angina is what when progressive angina?

A

becuase it is progressively getting worse due to emboli or thrombi, medical attn requried

39
Q

preinfarct angina is what when crescendo angina?

A

up/down angina for no reason= requires medical attn cuz could be thrombi or emboli

40
Q

Prinzmetal’s, Vasospastic, or Variant Angina:

A

Symptoms similar in nature to typical angina, but caused by coronary spasms.

41
Q

Prinzmetal’s, Vasospastic, or Variant Angina: common demographic

A

More common in women younger than 50 years

42
Q

Decubitus or Resting Angina:

A

Atypical. Occurs at rest and at the same time each day.

43
Q

Decubitus or Resting Angina relief

A

standing or sitting, ctrl breathing

44
Q

Decubitus or Resting Angina is due to

A

hormone flux/change

45
Q

Decubitus or Resting Angina is sometimes

A

painless but can be seen on an EKG

46
Q

Angina does what?

A

Increased oxygen needs of the heart
Increased cardiac output
Reduced blood flow to the heart

47
Q

What accounts for 90% of angina cases?

A

CAD accounts for 90% of all cases of angina

48
Q

etiology angina

A 
Antihypertension drugs
Relative hypotension
Blood loss
Physical exertion
All because heart is not getting enough oxygen supply
49
Q

Drugs typically used for angina

A

Organic nitrates
Beta blockers
Calcium channel blockers

50
Q

Organic Nitrates are what kinds of drugs and why?

A

Drug precursors (prodrug) meaning that they enter body in an inactive form but gets converted to active form in the body

51
Q

Orgo nitrates are converted to ?

A

Converted to nitric oxide in the body

52
Q

what do orgo nitrates do physiologically speaken? how?

A

Vasodilator: Increases the production of cGMP inhibiting smooth muscle contraction

53
Q

What were orgo nitrates orginnaly thought to do?

A

Originally thought to dilate the coronary arteries, therefore, increasing the blood flow to the myocardium, thus, increasing myocardial oxygen supply.

54
Q

What do orgo nitrates acutally do?

A

Primary anti-angina effect elicited via a generalized vaso-dilation of the systemic vasculature, not just the coronary arteries.
Decreased cardiac preload
Decreased cardiac afterload

55
Q

orgo nitrates seem to decrease what?

A

Organic nitrates seem to decrease myocardial oxygen demand more than they increase oxygen supply to the myocardium

56
Q

orgo nitrates decrease

A

total cardiac work via decreasing cardiac preload and afterload

57
Q

Nitroglycerin (orgo nitrate) sublingual take effect

A

in ~ 2 min

58
Q

nitroglycerin buccally

A

extended release and is good for long duration usage

59
Q

nitroglycerin transdermal route is for

A

prophylaxis, protection for just in case

60
Q

nitroglycerin transdermal route issue

A

results in drug toleration at enzymatic level, not receptor down regulation, but enzyme up-regulation

61
Q

what is the frequent cause of angina with exs or activities of daily lviing performance is

A

valsava maneuver

62
Q

Syndrome x

A

Anginal pain that does not respond to nitroglycerine, and is not derived from hyperspastic coronary arteries, reduces QOL, impacts moderate functional limitations, and results in ST segment depression.

Medical Perspectives 411 (9 decks)

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