Chapter 10: Angina Pectoris/MI Flashcards
What is IHD?
Ischemic heart disease; aka myocardial ischemia;
Pathological condition caused by lack of oxygen to the tissue
What is the most common cause of IHD and subsequent MI?
Atherosclerosis
What is Coronary Artery Disease and what are the risk factors?
Atherosclerosis of the coronary arteries; Gender Age Heredity/race Obesity Physical inactivity Tobacco HBP High Cholesterol
How is GENDER a risk factor for CAD?
Males more than females;
Most likely due to hormonal status in women;
Post-menopausal women higher risk for CDH than pre-menopausal women;
Hormone replacement therapy may reduce risk
How is AGE a risk factor for CAD?
Increasing age, greater risk;
Result of progressive atherosclerosis
How is HEREDITY including race a risk factor for CAD?
Family history is a risk;
African Americans have highest CHD mortality rate;
Middle-aged, black men have highest mortality rate;
Non-Hispanic whites have second highest mortality rate;
African American women have higher CDH mortality rate than non-Hispanic women
How is tobacco use s risk factor for CDH?
Smokers are 2-4 times more likely to develop CHD;
Accelerates development of coronary plaques and promote rupture and coronary thrombosis
How is HYPERTENSION a risk factor for CDH?
Individuals over 50 with systolic BP > 140mmHg have significant risk factor for CDH
What is hypercholesterolemia?
Too much cholesterol results in atherosclerosis and CDH;
Cholesterol-waxy, fat-like substance made in liver
How is diabetes a risk factor for CDH?
Common complication of diabetes is CDH due to atherosclerosis;
Atherosclerosis is accelerated and more severe in diabetics;
75% if diabetics die from some form of CVD;
Damage done to the large blood vessels due to atherosclerosis in diabetics is macroangiopathy
How are OBESITY and PHYSICAL INACTIVITY risk factors for CHD?
Obesity often results in type 2 diabetes;
Weight control, diet, and exercise can reduce hypertension and hypercholesterolemia
What is angina pectoris?
Inadequate supply of oxygen to the heart;
Usually induced by an increased demand for oxygen
What causes atherosclerosis?
A build up of plaques of the inner walls of large and medium-sized arteries;
As plaque deposits increase in size they restrict the opening of the artery, resulting in decreased oxygen to heart
What can result in an infarction where the tissue not receiving blood dies?
Occlusion of the artery
What are the forms of Angina?
Stable
Unstable
Variant (aka Prinzmetal’s)
What is Stable Angina?
Aka typical, chronic, classic, exertional;
Usually related to CAD;
Usually induced by physical activity or stress and symptoms are worse in cold weather or after a large meal;
Usually discomfort in left area of chest lasting from 1-15 minutes
What is used to treat Stable angina?
Nitroglycerin
When is angina considered stable?
If there has been no change in frequency, etiology, or duration of symptoms in the last 60 days
Can patients with stable angina still receive dental care?
Yes, appointments should be short and minimally stressful
What is the best time of day to treat a patient with stable angina?
Late morning and afternoon appointments;
Endogenous epinephrine levels peak during the morning, and most heart attacks occur between 8a-11a
What is Unstable Angina?
Aka preinfarctory angina, coronary insufficiency, crescendo angina, intermediate coronary syndrome, premature or impending MI;
Between stable angina and MI
How many Classes of Unstable Angina are there?
3
Class I, II, III
Class I Unstable Angina
New onset of severe angina with no pain at rest
Class II Unstable Angina
Subacute angina within past month, but not in preceding 48 hours
Class III Unstable Angina
Acute angina within 48 hours
Should patients with unstable angina receive dental care?
Only minimal or emergency dental care after consulting MD
How is unstable angina treated?
Nitroglycerin may of may not relieve anginal pain;
Patient is at risk for MI
Vasoconstrictor contraindicated
What is Variant Angina?
Aka Prinzmetal’s, atypical, vasoplastic angina;
Occurs spontaneously, usually while person is at rest and at odd hours of the day or night;
More common in women under 50;
Low risk for CAD
What is the etiology of Variant Angina, and what is the treatment?
Etiology is transient spasm of coronary artery causing brief occlusion of vessel;
May or may not have atherosclerosis;
Nitroglycerin usually provides prompt relief
Signs and symptoms of stable angina
Generalized chest discomfort: pressure, burning, heaviness, squeezing, or choking; Radiates to left shoulder, arm, neck, lower jaw, or tongue; Diaphoresis Pallor Nausea Vary in intensity Last 1-15 minutes Increased pulse and BP
Signs and symptoms of unstable angina
Same symptoms as stable, but may occur for no apparent reason;
Intensity may be more acute;
May last up to 30 minutes
Signs and symptoms of variant angina
Same symptoms as stable, plus Palpitations Syncope Dyspnea More likely to occur at rest
What is the treatment protocol for angina?
Terminate treatment;
Semi-supine or upright position;
Asses ABC’s;
Administer oxygen, 3-6L/minute via nasal cannula or non-rebreather bag
Monitor vital signs;
Administer sublingual or transmucosal nitroglycerin (dilates coronary blood vessels resulting in decreased CO), usually .3-.6mg
How do you administer nitroglycerin to an anginal patient?
Use patient’s own medication if current;
Will fell tingling sensation on tongue if fresh;
Administer one tablet every 5 minutes up to 3 doses (usually alleviates symptoms in 2-4 minutes)
Nitro contraindicated in hypotensive patients
What happens after administration of nitroglycerin?
Patient may experience: tachycardia, flushing, pounding in head, hypotension;
May resume treatment if patient feels well enough
When do you call EMS in an anginal patient?
If chest pain is not relieved in anginal patient after second dose;
Contact immediately if patient states that symptoms are more severe than normal;
Also contact if chest pain occurs in a patient no known history of angina, and follow steps for treatment of anginal patient
What is an AMI?
Acute Myocardial Infarction;
Necrosis of a portion of the myocardium due to total or partial occlusion of a coronary artery
What causes an AMI?
Atherosclerosis Thrombus Spasm May form rapidly or over a period of time MI can lead to cardiac arrest
What may occur after an MI and has a high risk of death?
Cardiac dysrhythmia
What are the types of cardiac dysrhythmia?
Bradycardia
Ventricular tachycardia
Ventricular fibrillation
Asystole
What is ventricular tachycardia?
Rapid contraction with inadequate ventricular filling
What is ventricular fibrillation?
Disorganized, irregular contraction of ventricles
What is asystole?
Absence of heart contraction
What are the signs and symptoms of AMI?
Classic symptom: chest pain lasting 20 minutes or longer;
Pressure, tightness, heaviness, burning, squeezing, crushing sensation in middle of chest and/or lower 1/3 of epigastrium;
Pain may radiate down arms, shoulders, jaw, or back;
Diabetics suffer silent MIs
Other symptoms of AMI?
Weakness Dyspnea Diaphoresis Irregular pulse Nausea Vomiting Sense of impending doom Clutching chest (Levine Sign)
Signs and symptoms of AMI in women?
Atypical discomfort
Upper abdominal pain
Shortness of breath
Fatigue
How do you treat a patient experiencing an AMI?
Terminate procedure;
If there is a history of angina, follow protocol for angina;
If no history, call EMS right away;
Position patient comfortably, usually upright or semi-supine;
Assess ABCs
Administer oxygen 4-6L/minute via nasal cannula;
Monitor vital signs
Administer nitroglycerine from emergency kit (3 doses over 15 minute period)
What do you do after administering nitro to a patient experiencing an AMI?
If pain diminishes and then returns, most likely AMI;
Administer aspirin chewed 325mg (anti thrombotic effect-clinical effect reached in 20 minutes);
Manage pain with nitrous oxide if available;
If cardiac arrest occurs, performed CPR with an AED
1. The most common cause of myocardial ischemia is A. obesity B. cigarette smoking C. atherosclerosis D. hypertension
C. atherosclerosis
2. The age advantage that women have over men in the development of CHD is most likely related to A. better lifestyle habits B. the protective effects of estrogen C. a lower incidence of hypertension D. a lower incidence of diabetes
B. the protective effects of estrogen
- Cigarette smoking contributes to the development of coronary artery disease in all of the following ways except one. Which one is the exception?
A. Tobacco use accelerates the development of coronary plaques.
B. Tobacco use promotes plaque rupture.
C. Tobacco use promotes coronary thrombosis.
D. Tobacco use causes vasodilation and hypotension.
D. Tobacco use causes vasodilation and hypotension.
- In individuals over the age of 50, systolic blood pressure greater than ______ is a more important risk factor that diastolic blood pressure.
140mmHg
5. If a patient with angina has had no changes in the cause, frequency, or duration of anginal symptoms in the previous 60 days, he or she is considered to have A. unstable angina B. stable angina C. vasoplastic angina D. variant angina
B. stable angina
6. A sharp, stabbing chest pain that can be localized and is aggravated by movement or breathing is symptomatic of A. variant angina B. unstable angina C. non-cardiac-related chest pain D. an acute myocardial infarction
C. non-cardiac-related chest pain
Blood pressure classifications for adults
Normal
Prehypertension
Stage 1 Hypertension
Stage 2 Hypertension
- Patients who present to the dental office with unstable angina
A. can be treated in the dental office if their vital signs are monitored throughout the appointment
B. can receive emergency dental treatment after consulting with a physician and preferably in a hospital setting.
C. can receive a local anesthetic with epinephrine safely
D. can receive a local anesthetic with epinephrine but the maximum dose of the vasoconstrictor should not exceed 0.04mg
B. can receive emergency dental treatment after consulting with a physician and preferably in a hospital setting.
What is normal BP for an adult?
<80
- The protocol for management of a patient with nip history of angina and who is experiencing anginal-like chest pain includes
A. administering 3 doses of nitroglycerin over 15 minutes prior to activating the EMS system
B. administering one dose of nitroglycerin and activation of the EMS system if the pain continues for two minutes or longer
C. immediately administering 81mg of aspirin
D. Positioning the patient in s Trandelenburg position because he or she is probably having an anxiety attack.
B. administering one dose of nitroglycerin and activation of the EMS system if the pain continues for two minutes or longer
What are the different causes of unstable angina that are currently recognized and are not necessarily mutually exclusive?
Nonocclusive thrombus on a preexisting plaque;
Coronary spasm or vasoconstriction (dynamic obstruction);
Progressive mechanical obstruction;
Inflammation and/or infection;
Secondary unstable angina
When and where do most deaths from AMI?
More than half occur outside the hospital;
Most within the first four hours after onset of symptoms
What BP is considered prehypertension?
120-139/80-89
9. During the first 1-2 hours following the onset of symptoms of an AMI, the greatest risk for death is the development of A. cardiac dysrhythmias B. dyspnea C. diaphoresis D. pulmonary edema
A. cardiac dysrhythmias
What is secondary unstable angina?
Primarily related to an increase in demand for oxygen by the myocardium in the presence of a restricted oxygen supply
Acronym for treatment of an anginal attack
R.E.P.A.I.R.
Recognize signs and symptoms
Evaluate to determine if chest pain is cardiac related
Position patient semi-upright or upright
Activate ABCs of CPR
Implement appropriate emergency protocol for anginal attack
Refer to ED
What BP is considered stage 1 hypertension?
140-159/90-99
10. It is recommended that out-of-hospital AMI victims begin fibrinolysis as soon as possible as the symptoms are recognized. The recommended drug is A. 5mg warfarin B. 7mg Coumadin C. 162-325mg acetylsalicylic acid D. 50mg aspirin
C. 162-325mg acetylsalicylic acid
What BP is considered stage 2 hypertension?
160+/100+
