angina pectoris

Question 1

angina pectoris is a manifestation of?

Answer 1

coronary artery disease BUT also a disorder itself

Question 2

angina=

Answer 2

angina= pain, pectoris= chest

chest pain

Question 3

what kind of pain?

Answer 3

ischemic pain

-inadequate perfusion to area of heart wall, not meeting demand

Question 4

etiology of angina pectoris?

Answer 4

• d/t atherosclerosis in most cases
• thrombus
• hemorrhage
• vasospasm (vessel constricts and stays in constricted position, tissue distal is ischemic)

Question 5

pathophysiology of angina pectoris?

Answer 5

arteries NORMALLY dilate on demand BUT if vessel has atherosclerotic change it may be already compensating by vasodilating and CANT any further!
—> inadequate perfusion —> ischemic —> chest pain

Question 6

manifestations of angina pectoris?

Answer 6

• CHEST PAIN
  -heart wall is impacted from vessels in coronary circuit not providing adequate blood and oxygen to heart cells
  -“squeezing, burning” pain
  -transient to severe
  -radiates to UPPER ARM SHOULDER NECK JAW
  typically LEFT UPPER ARM and SHOULDER

Question 7

types of angina?

Answer 7

stable
variant/vasospastic/prinzmetals
unstable

Question 8

what is stable angina?

Answer 8

FIXED plaque within wall of vessel
PROTRUDING into lumen
at REST, pt has enough adequate blood flow
PAIN occurs when metabolic demand of heart INCREASES
d/t:
a) exertion (physical activity)
b) emotional stress
c) cold- vessels automatically constrict to reduce BF to periphery so heat is not lost, causes systemic response and arteries, decreased BF to heart
^^ all perfusion to heart is IMPAIRED= pain

Question 9

what is unstable angina?

Answer 9

atheroma/plaque can rupture through wall of vessel into lumen, causing bleeding
-atheroma contains necrotic and foam cells that LEAK out fibrin and cell debris and platelets
-THROMBUS forms in lumen once plaque ruptures and has potential to dislodge “unstable”
-prostaglandin released from platelet aggregation —> triggers vasospasm —> vessel constricts —> cuts off lumen even further
PAIN more SEVERE, LONGER PAIN
-cannot withdraw trigger! pain occurs ANYTIME, ECG changes

Question 10

what is variant/vasospastic/prinzmetals angina?

Answer 10

• SPASM of artery in CORONARY circuit
• unclear etiology, could be:
  a) abnormal epithelium- SM in vessel wall constricting when doesnt need to
  b) calcium ions- calcium channel blocked, SM cells inadequately handling Ca
  c) sympathetic ns- hyperactivity of SNS, excessive stimulation of SM cells
  d) nitric oxide- chemical compound involved in vasodilation, if decreased conc, vasoconstriction
• triggered at ANYTIME
• TRIGGER UNKNOWN so difficult to manage
• DIFFICULT TO ASSESS bc can not be triggered on demand when usually u would watch the ECG by triggering angina

Question 11

Treatment of angina?

Answer 11

-rest/cease activity
-nitroglycerin!! (increase nitric oxide in cells, vasodilator)
comes in aerosal spray, patch, sublingual
systemic vasodilation
-avoid trigger to prevent recurrent episodes and decrease risk of MI!