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Cardiology Part I > Angina Pectoris Lecture Powerpoint > Flashcards

Angina Pectoris Lecture Powerpoint Flashcards

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1
Q

Recall the coronary circulation (right and left) of a right dominant heart (the posterior descending artery comes off the right coronary)

A
  • right coronary artery
  • right marginal artery branches off to supply lateral right side of heart,SA node, and AV node
  • right coronary becomes posterior descending artery that goes around the back of the heart
  • near apex anastamoses with anterior interventricular artery
  • left coronary artery
  • left anterior descending artery branches off and supplies the interventricular septum and anterior walls of both left and right ventricles
  • Left anterior descending artery becomes anterior interventricular artery and anastamoses with posterior interventricular artery
  • left coronary becomes circumflex artery and supplies left atrium and posterior wall of left ventricle
  • circum
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2
Q

Angina pectoris

A

Chest, jaw, shoulder, back, or arm pain/discomfort sometimes associated with other symptoms such as SOB often due to coronary artery disease ischemia but can be due to ANY imbalance in myocardial o2 supply and demand, many can continue to live with the partial occlusion but coronary artery disease is cause of 1/7 deaths in US

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3
Q

Ischemia vs infarct

A

Ischemia is lack of adequate oxygen supply causing tissue damage, infarct is when tissue has died permanently

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4
Q

If a patient has one atherosclerotic plaque, they likely have….

A

….many more in different parts of circulation

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5
Q

Any situation that causes ________________ can cause angina syndrome

A

imbalance in myocardial oxygen supply and demand

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6
Q

Shortness of breath in elderly may be a manifestation of…

A

….anginal or ischemic chest pain

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7
Q

3 factors that determine if myocardial ischemia will occur

A
  • O2 carrying capacity of blood
  • coronary artery blood flow
  • myocardial workload
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8
Q

Factors affecting o2 carrying capacity of blood (2)

A
  • hemoglobin conc

- degree of o2 unloading to the tissues

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9
Q

Factors affecting coronary blood flow (4)

A
  • coronary artery diameter and tone (cardioesophageal reflex)
  • collateral blood flow (vessels that develop as result of prolonged ischemia - angiogenesis)
  • perfusion pressure
  • vasospasm, fibrosis, dissection, etc
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10
Q

Coronary artery blood flow occurs during which phase of the cardiac cycle?

A

diastole

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11
Q

GI acid reflux issue presentation can be an indicator of ____ pathology that needs to be ruled out

A

coronary infarct

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12
Q

Postprandial angina

A

Angina that occurs as a result of blood flow being redirected to digest food causing ischemia to the coronary arteries

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13
Q

Steal phenomenon

A

Redistribution of blood to compensate for or as a result of a specific condition that can cause a shortage of blood flow to a tissue

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14
Q

Factors affecting myocardial workload (3)

A
  • heart rate
  • myocardial contractility
  • afterload
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15
Q

Angina pain origin mech of action

A
  • Ischemia reduces formation of ATP
  • causes acidosis
  • loss of membrane integrity of myocardial cells
  • stimulates chemoreceptors and mechanoreceptors in the cardiac vessel
  • release of lactate, seratonin, bradykinin, histamine, and adenosine
  • Afferent nerve fibers that travel along pathways from the heart in the upper thoracic and lower cervical spinal cord causes referred discomfort to dermatomes that supply afferent nerves to the same segments of the spinal cord as the heart
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16
Q

Quality of angina pain

A

-often difficult to locate and describe, more like discomfort and squeezing or pressure or burning, NOT sharp, dull aching, stabbing, positional, or reproducible by palpation

17
Q

Levine sign

A

Positive when patient places his or her fist on the center of the chest indicative of angina pectoris

18
Q

Timing of angina pain (2 things)

A
  • typically gradual in onset and offset (increasing and decreasing pain over 2-5 min)
  • common in the morning due to diurnal rise in sympathetic tone
19
Q

Radiation of angina to other parts of the body, particularly to both arms, is a strong predictor of…

A

….acute MI

20
Q

Differential diagnosis of angina (7)

A
  • Pericarditis
  • aortic dissection
  • PE
  • gallbladder or liver distension
  • pneumonia
  • thoracic outlet syndrome
  • peptic ulcer
21
Q

Big 5 that must be ruled out when a patient presents with chest pain

A
  • acute coronary syndrome (MI, unstable angina)
  • aortic dissection
  • PE
  • tension pneumothorax
  • esophageal rupture
22
Q

Things that often relieve angina (3)

A
  • rest
  • nitroglycerin (smooth muscle relaxant)
  • sitting up
23
Q

Stable angina

A

Predictable, usually follows a precipitating event, that is generally the same severity as previous attacks, relieved by rest or by the customary dose of nitroglycerin. Caused by fixed coronary artery obstruction 2ndary to atherosclerosis

24
Q

Prinzmetals’ variant angina

A

Occurs at rest, typically between midnight and 8am, manifests electrocardiographically as episodic ST segment elevations, caused by coronary artery spasms without superimposed CAD (no plaques found in coronary arteries that elicit the symptoms), patients also more likely to develop ventricular arrhythmias, may be triggered by stress, cold, hyperventilation

25
Q

Microvascular angina - cardiac syndrome X

A

Angina symptoms, positive exercise test (ST segment depression), normal coronary angiograms so no coronary spasm, patient does not have any other cardiac or systemic diseases (hyperension, diabetes) known to influence vascular function. Defective endothelium dependent dilation in the coronary microcirculation contributes to the altered regulation of myocardial perfusion and the ischemic manifestations predominantly in women. 2% risk of death or MI at 30 days of follow up

26
Q

Unstable angina

A 
New onset (makes it unstable by definition).  Increasing severity, duration, or frequency of chronic angina of another type.  Occurs at rest or minimal exertion.  Not relieved by typical measures.  No release of enzymes and biomarkers of myocardial necrosis. 
 Disrupted atherosclerotic plaque and overlaid thrombi is present in many cases of unstable angina.
27
Q

Acute coronary syndromes

A

-occurs with ST elevation MI, non ST elevation MI, or unstable angina, require immediate catheterization

28
Q

NY Heart Association Functional Classification of Angina

A

Class 1 - usually only with strenuous activity
Class II - slightly more prolonged or slightly more vigorous activity
Class III - angina with usual daily activity
Class IV - Angina at rest

29
Q

PE signs of ischemia (6)

A
  • tachycardia
  • elevation in bp
  • paradoxic splitting of S2
  • S3 or S4 presence
  • precordial pulsation
  • new mitral regurgitation murmur
30
Q

Lab studies for angina (6)

A
  • EKG
  • CXR
  • CBC
  • electroyte levels
  • cardiac enzyme levels
  • serum homocysteine
31
Q

Ranolazine (ranexa) can be a useful substitute for ___ to relieve symptoms of patients with stable ischemic heart disease

A

B blockers

32
Q

Stable angina treatment (4)

A
  • Risk factor modification
  • aspirin
  • B blockers
  • nitroglycerin
33
Q

Stable vs unstable angina

A

Stable angina is predictable and fixed with a known onset and treatment, unstable is new onset and or increasing severity or not responding to treatment

34
Q

Who often experiences silent ischemia? (3)

A
  • diabetics/obese
  • women
  • geriatric patients
35
Q

How many Americans have angina?

A

10 million

36
Q

Cardioesophageal reflex

A

A reduction in coronary blood flow by constriciton via a neural reflex when the esophagus is stimulated by acid reflux (in cases of chronic acid reflux could manifest as angina)

37
Q

Stress testing and absolute contraindications to it

A
  • Graded exercise test used to evaluate chest pain and can be performed in conjunction with echocardiography or perfusion tests
  • acute MI, myocarditis, pericarditis, or symptomatic cardiac arrhythmias

Cardiology Part I (28 decks)

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