Angina and Myocardial Infarction Flashcards

1
Q

define angina

A

chest pain caused by reduced blood flow to the heart muscles

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2
Q

typical angina presents all three of what features?

A

precipitated by physical exertion, constricting discomfort in chest, neck, shoulder, jaw or arms, relieved by rest or GTN within 5 mins

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3
Q

how does atypical angina present?

A

with two of the typical angina features

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4
Q

in addition to the typical features, atypical angina can also present with?

A

GI discomfort
breathlessness
nausea

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5
Q

list factors that make a diagnosis of stable angina less likely

A

pain that is continuous/prolonged, unrelated to activity, brought on by breathing, associated w/ dizziness, palpitations, tingling, or difficulty swallowing

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6
Q

what is the classification of angina?

A

stable
unstable
variant (prinzmetal)

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7
Q

what is stable angina?

A

pain or discomfort that occurs when the heart must work harder, usually during physical exertion; Usually lasts a short time (< 5min); Is relieved by rest or medicine

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8
Q

what is unstable angina?

A

Often occurs while you may be resting, last longer than stable angina; Rest or medicine do not help relieve it; get worse over time. It can lead to MI

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9
Q

what is variant (prinzmetal) angina?

A

pain is caused by a spasm in the coronary arteries caused by exposure to cold, stress, smoking etc

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10
Q

list some risk factors for angina/IHD

A
smoking
alcohol
family history
hypertension
advancing age
male gender
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11
Q

what tests can be useful for angina?

A

ECG, Coronary Angiography, Exercise Tolerance test, Lab tests (Complete blood profile, lipids, renal tests, liver function tests, cardiac enzymes)

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12
Q

list important cardiac enzymes to test for in a patient with angina

A

troponin
myoglobin
CK-MB
BNP

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13
Q

how to manage a patient with symptomatic angina?

A

1st line > lack of response > 2nd line > lack of response > consider revascularization

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14
Q

list first-line options for treatment of stable angina

A

short acting nitrate + beta blocker or CCB
low HR try DHP CCB
symptoms remain uncontrolled: conisider BB + DHP CCB

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15
Q

list second-line options for treatment of stable angina

A

long acting nitrate, ivabradnine, nicoradnil, ranolazine, trimetazidine

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16
Q

ECG findings: ST segment elevation in leads I, aVL and V6. Reciprocal changes in ST depression in inferior leads III and aVF. what is the diagnosis?

A

lateral STEMI

17
Q

list the types of MI based upon areas of infarct

A
anterior
lateral
inferior
posterior
septal
18
Q

what is the coronary artery territory involved in anterior MI?

A

left coronary artery and left anterior descending artery

19
Q

what is the coronary artery territory involved in lateral MI?

A

circumflex

20
Q

what is the coronary artery territory involved in inferior MI?

A

right coronary artery

21
Q

what is the coronary artery territory involved in posterior MI?

A

right coronary artery and circumflex

22
Q

what is the coronary artery territory involved in septal MI?

A

left anterior descending

23
Q

what reciprocal changes occur in an anterior MI?

24
Q

what reciprocal changes occur in an lateral MI?

25
what reciprocal changes occur in an inferior MI?
I | aVL
26
what reciprocal changes occur in an posterior MI?
none
27
what reciprocal changes occur in an septal MI?
none
28
ST segment elevation is seen in what leads in anterior MI?
V1 V2 V3 V4
29
ST segment elevation is seen in what leads in lateral MI?
I aVL V5 V6
30
ST segment elevation is seen in what leads in inferior MI?
II III aVF
31
ST segment elevation is seen in what leads in posterior MI?
V7 V8 V9
32
ST segment elevation is seen in what leads in septal MI?
V1 | V2
33
first line management for STEMI?
antiplatelet and add-on anti-ischemic /anticoagulant treatment > reperfusion therapy 1st line PCI alt is thrombolysis or rescue PCI or CABG
34
long term management for STEMI?
antiplatelet therapy, statin, b-blocker, ACE inhibitor, cardiac rehabilitation and lifestyle changes
35
ECG findings: ST depression in lead II, III. T wave inversions. what is the diagnosis?
NSTEMI
36
what is the pathological difference between NSTEMI and unstable angina?
NSTEMI: incomplete thrombus formation > oxygen starvation > tissue death unstable angina: unstable plaque > fibrous cap disrupts > thrombus forms > still enough lumen to meet demand at rest
37
what is the difference between NSTEMI and unstable angina?
no ST elevation | unstable angina has normal troponins, NSTEMI has raised troponins