Angina Pectoris Flashcards
This is a strangling/uncomfortable sensation in the chest and neighboring anatomic structures caused by myocardial ischemia.
Vagina pectoris
This type of vagina is predictable, transient, and elicited by exertion or emotional stress.
Chronic stable vagina
What forms in the coronary arteries to cause chronic stable angina?
Atheromatous plaque
In chronic stable angina, there is endothelial dysfxn, which results in the inability of the vessels to do what?
Dilate
This subtype of chronic stable angina is when there is a constant amount of physical activity that’s required to induce angina.
Fixed threshold
What are the alterations to cause the variable chronic stable angina?
vascular tone over the sites of fixed stenosis
This type of vagina results when some1 with stable angina starts to have sudden increases in tempo and duration of ischemic episodes that occur with lesser degrees of exertion
Unstable vagina
lol ok ill stop.
Unstable vagina (I DIDNT STOP HAHAHA) is usually a precursor to what gnarly condition?
MI
Unstable angina and MI are classified as what “syndromes”?
Acute coronary syndromes
What happens to the atherosclerotic plaque to cause platelet aggregation and thrombosis in acute coronary syndromes?
rupture
This type of angina is when a pt gets episodes of focal coronary artery spasm in the absence of overt atherosclerotic lesions.
Variant (prinzmetal) angina
SO F-ING METAL
Which nervous pathway may be increased in activity in combo with endothelial dysfxn to cause variant angina?
SANS
True or False: variant angina occurs typically at rest.
True!
True or False: typically, angina presents with 5-10 minutes of intense pain in the chest.
False. It’s usually a feeling of pressure, discomfort, tightness, burning, or heaviness
This sign is indicative of angina, where the pt puts their fist over their chest when describing the discomfort.
Levine sign
What are the accompanying Sx of angina?
tachycardia, disaphoresis, nausea, dyspnea, transient fatigue, and weakness.
This is the condition where there are episodes of cardiac ischemia, but the pt doesnt experience any perceptible pain or discomfort.
Silent ischemia
What % of pts with stable angina can have silent ischemia?
40%
This is the syndrome when pts have the Sx of typical angina pectoris, but there is NO EVIDENCE of significant atherosclerotic coronary stenosis on angiograms.
Syndrome X
queue the X files music
What is the most likely problem with the small coronary vessels to cause Syndrome X?
inadequate vasodilation
What is the most important part of the examination to find out which type of angina the pt has?
History
What 3 things must u ask about for the type of discomfort they feel?
percipitants, remission, frequency
What will you see on physical examination during an angina attack?
tachycardia, HTN, mitral regurg, palpatory ventricular contraction abnormalities, S4 gallop
Which test must u do during an angina attack?
EKG
What will happen to the ST segment during subendocardial ischemia?
depressions (with horizontal or downsloping)
What will happen to the ST segment during transmural ischemia?
ST elevation
What is the criteria for a + stress test for cardiac ischemia?
EKG showing ST depression
This is the test u can do at the peak of exercise, where u inject radionucleotides to see cold spots (areas of ischemia)
Myocardial perfusion imaging
After what 2 tests do u decide to do a PET scan?
- EKG. must have baseline abnormality
2. stress test. must be discordant.
Which heart chamber can be assessed during by echocardiography during an exercise echo?
LV
What happens to the LV to give a + exercise echo tests?
if regions of LV contractile dysfxn develop with exertion
So say your pt can’t exercise (like they broke their legs). What 2 drugs can u give to induce cardiac stress to test for angina?
inotropines (like dobutamine) or vasodilators
This test is the most direct way to look at the coronary arteries and is the gold standard to angina Dx.
Coronary angiography
What is a big limitation to coronary angiography (think anatomy)?
it only shows u physical problems, and can’t give u info about pathophysiilogical consequences, composition of plaques, or vulnerability to rupture.
CT is very good at viewing what type of change in coronary arteries?
calcification (but not much else)
Which drug can the pt take to cease the activity of acute angina?
Nitroglycerin
How can B-blockers help treat recurrent ischemic episodes of angina?
reduce myocardial O2 demand by decreasing chrono- and ionotropic events
What is the class of drugs to prevent acute cardiac events?
anti-platelet therapies
This is the procedure where they insert a balloon into the artery and inflate it to dilate the stenotic portion of the coronary artery.
PTCA (percutaneous transluminal coronary angioplasty)
What can be placed during a PCTA to prevent re-stenosis?
Stent
What can they coat the outside of the stent with to give a little antiproliferative properties to the opened artery?
drugs (sirolium, everoliums, paclitaxel)
What is the most common vessel to be used in a CABG surgery?
Saphenous v.
