Angina and Myocardial Infarction Flashcards
define angina
chest pain caused by reduced blood flow to the heart muscles
typical angina presents all three of what features?
precipitated by physical exertion, constricting discomfort in chest, neck, shoulder, jaw or arms, relieved by rest or GTN within 5 mins
how does atypical angina present?
with two of the typical angina features
in addition to the typical features, atypical angina can also present with?
GI discomfort
breathlessness
nausea
list factors that make a diagnosis of stable angina less likely
pain that is continuous/prolonged, unrelated to activity, brought on by breathing, associated w/ dizziness, palpitations, tingling, or difficulty swallowing
what is the classification of angina?
stable
unstable
variant (prinzmetal)
what is stable angina?
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
what is unstable angina?
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
what is variant (prinzmetal) angina?
pain is caused by a spasm in the coronary arteries caused by exposure to cold, stress, smoking etc
list some risk factors for angina/IHD
smoking alcohol family history hypertension advancing age male gender
what tests can be useful for angina?
ECG, Coronary Angiography, Exercise Tolerance test, Lab tests (Complete blood profile, lipids, renal tests, liver function tests, cardiac enzymes)
list important cardiac enzymes to test for in a patient with angina
troponin
myoglobin
CK-MB
BNP
how to manage a patient with symptomatic angina?
1st line > lack of response > 2nd line > lack of response > consider revascularization
list first-line options for treatment of stable angina
short acting nitrate + beta blocker or CCB
low HR try DHP CCB
symptoms remain uncontrolled: conisider BB + DHP CCB
list second-line options for treatment of stable angina
long acting nitrate, ivabradnine, nicoradnil, ranolazine, trimetazidine
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?
lateral STEMI
list the types of MI based upon areas of infarct
anterior lateral inferior posterior septal
what is the coronary artery territory involved in anterior MI?
left coronary artery and left anterior descending artery
what is the coronary artery territory involved in lateral MI?
circumflex
what is the coronary artery territory involved in inferior MI?
right coronary artery
what is the coronary artery territory involved in posterior MI?
right coronary artery and circumflex
what is the coronary artery territory involved in septal MI?
left anterior descending
what reciprocal changes occur in an anterior MI?
none
what reciprocal changes occur in an lateral MI?
III
aVF
what reciprocal changes occur in an inferior MI?
I
aVL
what reciprocal changes occur in an posterior MI?
none
what reciprocal changes occur in an septal MI?
none
ST segment elevation is seen in what leads in anterior MI?
V1
V2
V3
V4
ST segment elevation is seen in what leads in lateral MI?
I
aVL
V5
V6
ST segment elevation is seen in what leads in inferior MI?
II
III
aVF
ST segment elevation is seen in what leads in posterior MI?
V7
V8
V9
ST segment elevation is seen in what leads in septal MI?
V1
V2
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
long term management for STEMI?
antiplatelet therapy, statin, b-blocker, ACE inhibitor, cardiac rehabilitation and lifestyle changes
ECG findings: ST depression in lead II, III. T wave inversions. what is the diagnosis?
NSTEMI
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
what is the difference between NSTEMI and unstable angina?
no ST elevation
unstable angina has normal troponins, NSTEMI has raised troponins
