Angina and it's spectrum Flashcards
What is Prinzmetal’s Angina? Treatment?
Prinzmetal (variant) angina given the transient ST changes on ECG, lack of coronary artery occlusion, and noted coronary vasospasm on cardiac catheterization. Calcium channel blockers play a crucial role in the management of variant angina and are a first-line therapy due to their vasodilatory effect on the coronary vessels. Long-acting calcium channel blockers such as diltiazem, amlodipine, nifedipine, or verapamil are recommended and should be dosed on an individual basis and titrated to adequate response to minimize side effects.
Generally occurs at rest, Often occurs at night
Elevated shortly after the event, Normal otherwise
*Propranolol is a nonselective beta-blocker and may actually worsen vasospasm due to its beta-2 receptor blockade; therefore, it is contraindicated in Prinzmetal angina.
Acute Myocardial Infarction is what? What are the criteria needed?
The term acute myocardial infarction should be used when there is acute
myocardial injury with clinical evidence of acute myocardial ischaemia and
with detection of a rise and/or fall of cTn values with at least one value above
the 99th percentile and at least one of the following:
Symptoms of myocardial ischaemia;
New ischaemic ECG changes;
Development of pathological Q waves;
Imaging evidence of new loss of viable myocardium or new regional wall
motion abnormality in a pattern consistent with an ischaemic aetiology;
Identification of a coronary thrombus by angiography or autopsy (not for
type 2 or 3 MIs).
What is a type 1 MI?
MI caused by atherothrombotic coronary artery disease (CAD) and usually precipitated by atherosclerotic plaque disruption (rupture or erosion) is designated as a type 1 MI
What is a Type II MI?
The pathophysiological mechanism leading to ischaemic myocardial injury in the context of a mismatch between oxygen supply and demand has been classified as type 2 MI
Detection of a rise and/or fall of cTn values with at least
one value above the 99th percentile URL, and evidence
of an imbalance between myocardial oxygen supply and
demand unrelated to coronary thrombosis, requiring at
least one of the following:
Symptoms of acute myocardial ischaemia;
New ischaemic ECG changes;
Development of pathological Q waves;
Imaging evidence of new loss of viable myocardium
or new regional wall motion abnormality in a
pattern consistent with an ischaemic aetiology
What is a type III MI?
The detection of cardiac biomarkers in the blood is
fundamental for establishing the diagnosis of MI
However, patients can manifest a typical presentation of
myocardial ischaemia/infarction, including presumed
new ischaemic ECG changes or ventricular fibrillation,
and die before it is possible to obtain blood for cardiac
biomarker determination; or the patient may succumb
soon after the onset of symptoms before an elevation of
biomarker values has occurred. Such patients are designated as having a type 3 MI, when suspicion for an acute
myocardial ischaemic event is high, even when cardiac
biomarker evidence of MI is lacking
What is a type 4 and 5 MI?
Percutaneous coronary intervention (PCI) related MI is termed type 4a MI.
Coronary artery bypass grafting (CABG) related MI is termed type 5 MI
