Angina Flashcards
What part of the heart does the right coronary artery supply?
Right side, right atrium, pacemaker
Name the three layers of heart from outside to inside:
- Pericardium
- Myocardium
- Endocardium
What does a transmural ischemia mean?
That the entire myocardial does not receive blood.
The more the preload =
The more the force of contraction
When the O2 gets out of balance in the heart it cause:
Coronary artery disease
Artheriosclerosis =
Thickening and hardening of arterial walls
Why are women less likely to get arteriosclerosis?
Because of estrogen; it helps protect us from disease such as this and osteoporosis UNTIL menopause when estrogen levels go down.
What is medial sclerosis?
Degeneration and swelling in muscle layer, medium size vessels
What is arteriolar sclerosis?
Deposits in intima and media, smaller vessels
What is the difference between LDL and HDL?
LDL has a higher FAT content as opposed to proteins, whereas HDL has a higher PROTEIN contents and very little fat.
What is the pathophysiology of atherosclerosis?
- Damage to medium or large arteries, changing their structure
- Altered blood flow; causing increased resistance
- Decreased blood oxygen, decreased oxygen supply to tissues
What color are fatty plaques?
Yellow, thin, fat
What colour are fibrous plaque?
Grey/White
Calcium deposits are …
Hard deposits
What is the difference between embolisms and thrombosis?
A thrombosis is a blood clot that is STATIONARY.
A embolism is a travelling clot.
Describe steps in thrombi-embolism:
- Activation of coagulation
- Inflammation of endothelial
- If clot dislodges = thromboembolism
What are the four types of embolisms?
- Thromboembolism
- Air embolism
- Bacterial embolism
- Lipid embolism
What are the two types of causes for myocardial ischaemia?
-Atherosclerosis and coronary artery spasm
Define angina:
Decreased blood supply to the myocardium
What is stable angina?
Pain on exertion, no pain at rest
What is unstable angina?
Pain at any time, unpredictable
Define ischaemia:
Lack of oxygen supply.
If cells do not have oxygen what do they do?
They change from aerobic to anaerobic metabolism which leads to lactic acid build up!
What can lactic acid cause?
Local acidosis = pain
When cells build up lactic acid, what else can happen?
They can get damaged and release potassium ions. These are checked when pt’s come in, elevated K+ levels can indicate ischaemia.
Any cell damage from angina is reversible or irreversible?
Reversible
Injury =
Damage due to lack of oxygen
Infarction =
Death of cells/necrosis/infarction due to lack of oxygen
If oxygen is NOT restored within 20 minutes and the cells CANNOT repair themselves, those myocardial cells will…
Die, and it is called a myocardial infarction
How can diabetes cause atherosclerosis?
When there is no glucose for energy, it uses the fat and the fat product content in the blood rises, therefore increasing risk for atherosclerosis.
What are the S&S of angina pectoris?
Burning, central chest pain, dyspneoa, dizziness, anxiousness, tachycardia, pale, blood test, ECG, angiogram
What will we be looking for in the blood test for angina?
- Check for anaemia
- Cholesterol- a high LDL indicates the bad cholesterol in body
- Electrolytes- potassium and glucose
- Cardiac enzymes- we don’t want to see any of these!
Why do we do FBC regularly for suspected heart problems?
To check that everything goes back to normal, that cardiac enzymes disapear. If all the levels are elevated, it will indicate heart problem.
How much tissue injury is there in angina?
Only a small amount of tissue damage.
The straight line in an ECG for an A1 is called the:
Isoelectric line
The T wave inversion line indicates
Ischaemia
The T wave ECG line is only present when:
There is ischaemia at that exact time of testing.
What does ST segment elevation indicate?
Ischaemia and REVERSIBLE injury
What is an angiogram?
An X-ray photograph of blood or lymph vessels, made by angiography.
Define stenosis:
the abnormal narrowing of a passage in the body.
What are S&S of hyposxia/ischaemia of myocardium:
Angina, dysponea
What are S&S of anaerobic metabolism?
Lactic acid, pain
What are S&S of low SV and low CO?
Low BP, sweating, anxiety, dizziness
What are the S&S of the compensation to increase CO?
Tachycardia
What are the S&S of myocardial tissue damage and inflammation?
Pain
What are the principles of treatment for angina?
Increase myocardial oxygen supply Decrease myocardial oxygen demand Treat cause Prevent complications and start rehabilitation Specific treatment of the patient
What is the treatment plan for angina?
Diet, exercise
Monitor – weight, cholesterol, CVS + renal disease
Treat cause and reduce risk factors
Anti-lipaemic therapy
Anti-coagulation therapy
Surgery – angioplasty, endarterectomy, bypass surgery
Describe the methods used to improve the oxygen supply to the myocardium:
Coronary artery vasodilators Oxygen Calcium channel blockers Beta Blockers Streptokinase Angioplasty Coronary Artery Bypass graft
What is streptokinase?
Streptokinase (SK) is an enzyme secreted by several species of streptococci that can bind and activate human plasminogen. SK is used as an effective and inexpensive thrombolysis medication in some cases of myocardial infarction (heart attack) and pulmonary embolism.
What can we do to decrease the oxygen demand?
- Rest
- Peripheral vasodilators so that afterload goes down
- Negative inotropes
- Beta Blockers
- Diuretics
- Calcium channel blockers
What does a negative inotrope do?
It decreases the strength of contraction.
What kind of analgesia is used for angina?
- Glyceryl trinitrate
- Morphine
What is glyceryl trinitrate?
A vasodilater and an analgesia
