E3: Coronary Heart Disease Flashcards
Angina Pectoris, “Angina” (Chest Pain)
- clinical manifestations of myocardial ischemia
Prinzmetal’s Angina/Variant Angina
1. Definition and causes
–Reduced production of _______
2. Ischemia (is or is not) directly attributed to atherosclerosis
3. ↓ ____ flow
4. Pain duration if any
5. When does angina occur
6. Is it exercise tolerant?
- abrupt and transient coronary artery vasospasm resulting in ↓ in vessel diameter
-Vasoconstriction/Vasospasm of coronary artery
—-dysfunction of the coronary artery endothelium
—–Reduced production of vasodilator-NO
—–Narrowing of coronary arteries causing contraction of smooth muscles in vessel walls - Ischemia NOT directly attributed to atherosclerosis
- ↓O2 flow
- Pain not anticipated
- Angina occurring at rest (often at night)
- Exercise tolerant
Stable Angina/Exertional angina:
1. Define
2. ________ ________ atherosclerotic plaque
3. _____ -_______% Narrowing of…
4. Induced by:
5. Better w/rest?
6. Duration of pain if any
7. _________ _______ form of angina
- chronic reproducible/predictable pain associated w/physical activity
- Stable fixed atherosclerotic plaque
- 50-75% narrowing of coronary artery affected
- Usually (not always) induced by ↑ myocardial O2 demand (typically predictable onset on exertion)
- Complete reversibility of the symptoms w/rest over time
- Pain lasting 5-15 min
- Chronic early form of angina; chronic stable angina
Unstable angina
Define
2. Pain when? Or what happens to intensity of angina
3. Duration of pain
4. ___% vessel narrowing with ________ forming
5. don’t respond as well to ________ or ________ and sometimes presents asymptomatically
6. more prevalent in:
- abrupt cardiac ischemia
- chest pain at rest OR on exertion, or substantial change in angina intensity; more intense pain
- Pain lasts >15 min
- 75% vessel narrowing with thrombus forming
- often don’t respond as well to nitroglycerin SL or rest and sometimes presents asymptomatically
- don’t respond as well to nitroglycerin SL or rest and sometimes present asymptomatically
Myocardial Infarction/”Heart attack”
1. Type types
2. Chest pain ____ _______
3. _______ cardiac ischemia w/cardiac tissue necrosis
4. tissue biomarkers
5. don’t respond as well to ________ or ________ and sometimes presents asymptomatically
6. more prevalent in:
- STEMI/NSTEMI
- chest pain at rest
- abrupt cardiac ischemia with cardiac tissue necrosis
- accompanying cardiac tissue biomarkers ( ie troponin)
- often don’t respond as well to nitroglycerin SL or rest and sometimes presents asymptomatically
- don’t respond as well to nitroglycerin SL or rest and sometimes present asymptomatically
Ischemic Heart Disease (IHD)
Imbalance between myocardial oxygen demand and supply
A. demand exceeds supply
Factor that affect oxygen supply and what causes the factor
- coronary blood flow ↓
Caused by Atherosclerosis
—-↓ arterial diameter
vasoconstriction
Factor that affect oxygen demand and what causes the factor
↑ workload of the heart by:
↑ Heart rate
↑ Contractility
↑ preload, ↑ afterload
↑ systolic wall tension
Classic signs and symptoms associated w/angina
A. Quality/Pressure:
B. Location:
C. Radiation:
D. Duration:
E. Precipitating factors:
F. Relieving factors:
Other: (5)
A. Quality/Pressure: burning, heaviness, tightness, squeezing
B. Location: substernal, occasionally limited to left shoulder, arm, lower jaw
C. Radiation: left shoulder, left arm, neck, jaw, occasionally right arm
D. Duration: 0.5-30 min
E. Precipitating factors: exertion, emotional stress, large meals, cold temps
F. Relieving factors: response to nitroglycerin (sublingual, relief w/in 30 sec to 5 min) and rest
- Nausea
- vomiting
- Dyspnea (sensation of uncomfortable breathing)
- Diaphoresis (profuse sweating)
- Syncope (light-headedness, fainting)
Location of chest pain during angina or heart attack
- Upper chest
- Substernal radiating to neck and jaw
- Substernal radiating down left arm
- Epigastric
- Epigastric radiating to neck and arms
- Neck and jaw
- Left shoulder and down both arms
Intrascapular
Acute Coronary Syndrome Pathophysiology
- Build-up of atherosclerotic plaques
due to lipids, HTN, diabetes, smoking - rupture of the vulnerable plaque triggers thrombosis
A inflammation triggers plaque disruption
B Platelet activation/adhesion/aggregation –> clotting cascade activation –> fibrin and clot formation - extent of severity due to which vessel (coronary artery) blocked
Normal range of Tnl
Clinical significance of troponins
Troponins=Tnl
<1.5 ng/mL
Significance: most sensitive marker of MI; valuable in initial diagnosis following onset of chest pain
Unstable angina (UA)
Chest pain:
Coronary artery occlusion:
ECG changes:
↑ cardiac biomarker:
Myocardial cell death:
Chest pain: Most often observed; not only dependent on exertion or activity
Coronary artery occlusion: transient
ECG changes: ST segment depression or T-wave inversion or no changes
↑ cardiac biomarker: No
Myocardial cell death: No
Non-ST segment elevated myocardial infarction (NSTEMI)
Chest pain:
Coronary artery occlusion:
ECG changes:
↑ cardiac biomarker:
Myocardial cell death:
Chest pain: Most often observed; not only dependent on exertion or activity
Coronary artery occlusion: moderate
ECG changes: ST segment depression or T-wave inversion or no changes
↑ cardiac biomarker: yes
Myocardial cell death: yes/milder
STEMI
Chest pain:
Coronary artery occlusion:
ECG changes:
↑ cardiac biomarker:
Myocardial cell death:
Chest pain: Most often observed; not only dependent on exertion or activity
Coronary artery occlusion: Significant/total
ECG changes: ST segment elevation
↑ cardiac biomarker: yes
Myocardial cell death: always
