Angina pectoris Flashcards
Angina, what is it, what is the cause
- Angina is chest pain
- C: due to a reduced blood flow to the heart -> causing ischemia the to heart muscles -> causing chest pain
State the different types of angina
- Stable angina
- Unstable angina
- Prinzmetal angina
Stable angina: characteristics
- doesn’t experience pain during rest
- experiences pain during exercise, stress, and goes back to normal once the exertion/stress is taken away
Stable angina: Causes
- Atherosclerosis or coronary arteries (most common cause), blocking more than 70% of the arteries
- anything causing a thickened myocardium:
. Hypertrophic cardiomegaly
.pumping against high pressures (aortic stenosis, HTN)
Stable angina: type of ischemia and ECG findings
- subendocardial ischemia
- ECG: ST-depression (NSTEMI)
Stable angina: symptoms
- chest pain that lasts less than 20 mins, pain goes away once exertion/stress is taken away
- chest pain radiating to the left arm, jaw, shoulder, back
- dyspnea
- diaphoresis
Stable angina: Treatment
- nitroglycerin (vasodilator), aspirin (clopidogrel)
- beta blocker, ACE-1, Ca+ channel blockers
- Statins (<1.8mM)
- diet
Unstable angina: characteristics
- chest pain present during exercise/stress, and rest
- is an emergency -> has a high risk of developing into a myocardial infarct (heart attack)
Unstable angina: causes
- rupture of atherosclerotic plaque with thrombus formation
Unstable angina: type of ischemia and ECG findings
- subendocardial ischemia
- ECG: ST-depression (NSTEMI)
Unstable angina: treatment
- nitroglycerin, however, may not be completely relieved by nitroglycerin, which helps to differentiate it from stable angina
Difference between unstable angina and myocardial infarct
- unstable angina -> heart tissue is alive, but ischemic
- MI -> heart tissue has already begun necrosis
Prinzmetal angina (vasospastic): causes
- Ischemia from the coronary arteries due to vasospasm -> prevents O2 delivery -> causes ischemia
- just like unstable angina, occurs anytime, even at rest
Prinzmetal angina: type of ischemia, ECG
- transmural ischemia
- ECG: ST elevation (STEMI)
Prinzmetal angina: treatment
- nitroglycerin
- Ca2+ channel blockers
Major risk factors of Angina pectoris
- smoking
- DM
- increased cholesterol level
- HTN
- Obesity
- family history
- age
- gender
Stable angina: diagnosis
- LAB test
- ECG
- Echo, scintigraphy
Stable angina: revascularization techniques used
- PTCA: Percutaneous Transluminal Coronary Angioplasty
- CABG: Coronary Artery Bypass Grafting
Prinzmetal angina: RF
- smokers
- middle aged woman
Prinzmetal angina: complications
- can cause malignant arrhythmia
- needs urgent coronarography
When patient presents with chest pain: what to do
- Make sure the pain is of cardiac orginin, use PQRST pain assessment:
P: Position/ Provoking factors.
Where is the pain, what makes it better/worse, does the pain change when repositioning. AMI chest pain won’t change with repositioning, if it does, other origin. Common that women don’t experience chest pain with AMI.
Q: Quality
Describe the pain, and what kind of pain is it. AMI presents with classic sub-sternal chest pain.
R: Radiation
Is the pain radiating. Most of the time does radiate, left arm, left side of the jaw and back.
S: Severity/Symptoms
Can you rate the pain out of 10. What are the other symptoms. Other symptoms: nausea, vomiting, diaphoresis, dizziness, hypotension, bradycardia, scare.
T: Time
For how long, and is the pain intermittent (comes and goes) or continuous.
- Pain of cardiac nature: then
Increase O2 to the heart, and reduce O2 demand.
.O2 therapy: provide supplemental O2 in case of hypoxic patient (SpO2 less than 93%) only.
.Coronary vasodilators: Prescribe nitrate, unless patient has hypotension.
.Anti-platelet aggregator: Aspirin
To reduce the risk of thrombus formation.
.Relive pain: Give morphin
- What else to do ?
ECG, be near a defibrillator, perform a full blood examination.
