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CV > angina > Flashcards

angina Flashcards

1
Q

stable angina

A

usually due to atherosclerotic stenosis of coronary artery walls–> reduces coronary reserve

common feature = chest pain on exertion

usually relieved by rest or nitro

retrosternal chest pressure, burning or heaviness
radiating occasionally to head, neck, jaw, epigastrum, shoulders, left arm

S4 heart sound sometimes found during atrial contraction due to decreased ventricular compliance

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2
Q

how occluded must an artery be to cause symptoms of stable angina

A

75%

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3
Q

what causes the chest pain associated with angina

A

ADENOSINE is release in response to ischemia as it dilates blood vessels but it also stimulates nerve fibers causing chest pain

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4
Q

how does unstable angina differ from stable angina

A

occurs at rest or minimal exertion
artery must usually be 90% occluded

loss of predictability of angina attacks due to worsening of stenosis

may have crescendo pattern

NOT relieved by rest or nitro

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5
Q

atypical angina

A

do not have classic symptoms of chest pain but instead have symptoms such as

weakness
faintness
sweating
nausea

same causative pathophysiology however

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6
Q

in which patients is atypical angina most commonly seen

A

diabetics

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7
Q

cardiac causes of acute chest pain

A

angina
unstable angina
acute MI
pericarditis

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8
Q

vascular causes of acute chest pain

A

aortic dissection
pulmonary embolism
pulmonary HTN

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9
Q

pulmonary causes of acute chest pain

A

pleuritis and/or pneumonia
tracheobronchitis
spontaneous pneumothorax

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10
Q

GI causes of acute chest pain

A

esophageal reflux
peptic ulcer
gallbladder disease
pancreatitis

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11
Q

MSK causes of acute chest pain

A

costochondritis
cervical disc disease
trauma/strain

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12
Q

infectious causes of acute chest pain

A

herpes zoster

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13
Q

psychologic causes of acute chest pain

A

panic disorder

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14
Q

acute MI symptoms

A

may have symptoms of angina but potentially worse
sudden onset
usually lasting > 30 min
often associated with SOB, weakness, nausea, vomiting

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15
Q

pericarditis symptoms

A

SHARP, pleuritic pain aggravated by CHANGES IN POSITION

highly variable in duration

pericardial friction rub = distinguishing feature

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16
Q

aortic dissection symptoms

A

excruciating RIPPING pain of SUDDEN onset in ANTERIOR of chest, often radiating to back

marked severity of UNRELENTING pain

usually occurs in the setting of HTN or underlying CT disorder like Marfan syndrome

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17
Q

pulmonary embolism symptoms

A

sudden onset with DYSPNEA and pain
usually pleuritic with pulmonic infarction

dyspnea
tachycardia
tachypnea
signs of right sided heart failure

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18
Q

pulmonary HTN symptoms

A

SUBSTERNAL chest pressure
exacerbated by exertion

pain is associated with DYSPNEA and signs of pulmonary HTN

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19
Q

symptoms of pleuritis/pneumonia

A

pain is pleuritic and lateral to the midline

associated with dyspnea

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20
Q

tracheobronchitis symptoms

A

BURNING discomfort in the MIDLINE

associated with COUGHING

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21
Q

spontaneous pneumothorax symptoms

A

sudden onset of UNILATERAL PLEURITIC pain with DYSPNEA

22
Q

esophageal reflux symptoms

A

BURNING SUBSTERNAL and epigastric discomfort
10-60 minutes in duration

aggravated by large meal and postprandial recumbency

relieved by ANTACID

23
Q

peptic ulcer symptoms

A

PROLONGED epigastric or substernal BURNING

relieved by ANTACID or FOOD

24
Q

gallbladder disease symptoms

A

prolonged epigastric or UPPER RIGHT QUADRANT pains

unprovoked or following a meal

25
Q

pancreatitis symptoms

A

prolonged INTENSE epigastric and substernal pain

risk factors include alcohol, hypertriglyceridemia and meds

26
Q

costochondritis symptoms

A

sudden onset of INTENSE, FLEETING pain

may be reproduced by pressure over the affected area/joint

occasionally, swelling and inflammation over the costochondral joint

27
Q

cervical disc disease symptoms

A

sudden onset of fleeting pain that can be reproduced with movement of neck

28
Q

symptoms of MSK trauma

A

constant

reproduced with palpation or movement of best wall or arms

29
Q

symptoms of herpes zoster

A

prolonged BURNING pain in DERMATOMAL distribution

VESICULAR rash, dermatomal distribution

30
Q

what is variant angina

A

coronary artery spasms

these spasms are thought to be caused by increased SNS activity combines with endothelial dysfunction

spasms cause decreased blood flow and thus reduced oxygen supply

“prinzmetal angina”

31
Q

what inflammatory cells within a plaque can contribute towards decreasing its integrity

A

gamma interferon and MMP

32
Q

what is an NSTEMI

A

non-ST elevation MI

involves subendocardial tissue ischemia and NECROSIS (thats where it differs from unstable angina, the necrosis)

thrombus partially occludes the vessel

NSTEMI has higher degree of ischemia than unstable angina, therefore tissue damage/necrosis results

33
Q

symptoms of NSTEMI

A

similar to angina pectoris but usually has more severe CRUSHING PAIN and lasts longer

may radiate more and more widely

rapid onset and briskly crescendoes

evidence of SNS response–> diaphoresis, tachycardia, cool and clammy skin

not relieved by rest or nitro

S3 and/or S4 heart sounds are frequently present

34
Q

NSTEMI on ECG

A

ST depression and/or T wave inversion

35
Q

are there biomarkers associated with an NSTEMI?

A

yes because necrosis is present

36
Q

what is a STEMI

A

ST-elevation MI

transmural tissue damage

FULL occlusion + necrosis

37
Q

symptoms of STEMI

A

same as NSTEMI clinically but on ECG have ST elevation

38
Q

conservative Tx for stable angina

A

exercise
diet
smoking cessation
stress reduction

39
Q

pharmacological Tx for stable angina

A

acute angina episode = sublingual nitro

prevention of recurrent episodes =

  1. organic nitrates
  2. beta blockers
  3. Ca2+ channel blockers

prevention of MI=

  1. aspirin (an anti-thrombotic)
  2. lipid-regulating therapy
  3. ACE inhibitors
40
Q

invasive Tx for stable angina

A

revascularization

i.e coronary stents, drug eluting stentes, coronary artery bypass graft

41
Q

conservative treatment for unstable angina/NSTEMI

A

same as for stable angina

42
Q

pharmacological Tx for unstable angina/NSTEMI

A

same as for stable angina but you admin more aggressively

additional anti-thrombotics = HEPARIN

43
Q

invasive Tx for unstable angina/NSTEMI

A

same as for stable angina, but use invasions earlier in patients with high risk features (i.e ST deviation, elevated Trop-I, multiple CV risk factors)

44
Q

would you ever treat STEMI conservatively?

A

no–give meds or intervene ASAP

45
Q

pharmacological Tx for STEMI

A

same as for stable/unstable/NSTEMI but admin IMMEDIATELY

for STEMIs only: FIBRINOLYTICS

46
Q

invasive Tx for STEMI

A

primary PCI (percutaneous coronary intervention)–> immediate angioplasty and usually stenting

47
Q

indications for re-vascularization

A
  1. patients symptoms of angina do not respond adequately to anti-anginal drugs
  2. unacceptable side effects of meds occur
  3. patient is found to have high risk of CAD for which revascularization is known to improve survival
48
Q

percutaneous transluminal coronary angioplasty (PTCA)

A

performed under fluoroscopy

balloon tipped catheter inserted through peripheral artery (i.e femoral, brachial, radial) and manoeuvred into stenotic segment of coronary vessel

balloon inflated under high pressure to dilate the stenosis, then deflated and the catheter removed

requires an accessible lesion in the coronary artery with a small amount of patent lumen

approx 1/3 patients have recurrent symptoms within 6 months due to re-stenosis

49
Q

coronary stents

A

slender, cage like stainless steel devices that in their collapsed configuration can be threaded into the region of stenosis by a catheter

placed at the time of a PCI

once in place they are opened by expanding a balloon in its interior and then the balloon is removed

compared to PTCA it gives greater luminal diameter and has lower stenosis rates and thus lower need for repeat procedures, but, the stents are THROMBOGENIC meaning you must combine them with oral anti-platelet agents

50
Q

what works better for angina, percutaneous revascularization or meds?

A

revascularization

51
Q

does percutaneous revascularization reduce the risk of MI or death in stable CAD?

A

no

52
Q

coronary artery bypass graft (CABG)

A

grafting portions of a patients native blood vessels (i.e from saphenous vein, internal mammary arteries) to bypass obstructed coronary arteries

requires a bypassable lesion

50% stenosis in L main coronary or 2-3 vessel disease

preferable to angioplasty when there is a significant disease of more than 2 vessels

CV (9 decks)

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