Case 6 Flashcards
What causes stable angina pectoris?
Transiet myocardial ischemia
Angina is more common in who?
more common: males less than 50 years old
in women its atypical
what types of pain does a person feel in Angina?
heaviness, pressure, squeezing, smothering, or choking
How does a patient show u where the pain is if they’re suffering from angina?
they place their hand on the sternum with a clenched fist (LEVINE’S SIGN)
where does Angina typically radiate to?
shoulder and ulnar surfaces of forearm and hand, as well as the back, inter scapular region, root of neck, jaw, teeth, and epigastrium
How long does a stable Angina usually last?
2 - 5 mins (Crescendo-decrescendo)
How can u differentiate if the pain is caused by myocardial ischemia or something else?
myocardial ischemia does not radiate to the trapezius, and does not cause a sharp fleeting chest pain or a prolonged dull ache in the left submammary area.
What disease is indicated by pain radiation to Trapezius?
pericarditis
what causes typical angina? and how is it relieved?
exertion (exercise, sexual activity, emotion, hurrying)
relieved by rest
what type of angina is caused while the person is resting and recumbent?
Angina Decubitus
A patient is awakened with typical chest discomfort and dyspnea. Investigations showed episodic tachycardia, diminished oxygenation, with an expansion of intrathoracic blood volume. What is your diagnosis?
Nocturnal Angina
in Nocturnal angina, what does recumbency lead to?
increase in cardiac size due to expansion of intrathoracic blood volume (end diastolic volume)
What are causes of nocturnal angina?
1- episodic tachycardia
2- respiratory pattern changes during sleep
3- expansion of intrathoracic blood volume
4- wall tension
5- myocardial oxygen demand
6- transient left ventricle failure
How do u know if a patient has a stable exertional angina?
they know they have a fixed threshold that causes it, so coronary stenosis and myocardial oxygen supply are fixed. So Its precipitated by an increased oxygen demand
What causes a variation is the threshold of angina in some patients?
changes in coronary vasomotor tone
An elderly diabetic patient presents with dyspnea, nausea, fatigue, and faintness. What is your diagnosis?
myocardial ischemia
Why should we examine an angina patient for peripheral arterial diseases? and what could we find?
1- to uncover an unstable syndrome associated with increased risk.
2- presence of coronary atherosclerosis, stroke, or transient ischemic attacks
What are risk factor we may find in a patient’s family history?
in a <55 year old male and <65 year old female first-degree relative we may find 1- diabetes 2- hyperlipidemia 3- hypertension 4- cigarette smoking
What may be the reason behind persistent ischemic-type chest discomfort in women without flow-limiting obstructions?
1- microvascular coronary disease
2- abnormal cardiac nociception
How can we confirm that a patient has microvascular coronary disease?
1- by responding to vasoactive agents (intracoronary adenosine, acetylcholine, nitroglycerin)
How can we treat microvascular coronary disease and cardiac nociception?
1- improving endothelial function (by nitrates, beta blockers, calcium antagonists, statins, ACE inhibitors)
2- imipramine for nociception
In a physical examination, what should clinicians search for?
1- abdominal aortic aneurysm
2- carotid arterial bruits
3- diminished arterial pulses in lower extremities
What are evidence for risk factors of atherosclerosis?
1- xanthelasmas & xanthomas
2- protuberant abdomen caused by metabolic syndrome
How do we find evidence of peripheral arterial disease?
evaluating the pulse control (ankle-brachial index)
