Ischemic Heart Disease Flashcards
What kind of chest pains exist?
Acute or Chronic
what does ischemic refere to
decreases supply of oxygeeated blood
insuffienct to meet demenads
what angina pectoris
chest pain due to IHD
Stable IHD
Chronic Stable angine
what is acute coronary syndrome
ST elevation myocardial infarction (STEMI)
non-ST elevation acute cornonary syndrome NSTEACS
- unstable angine
- non ST elevation myocardial infarction (NSTEMI)
locations of atherosclerotic syndrome
Coronary arteries -CAD
Peripheral arteries - PAD
cerebral or carotid arteries - cerebrovascular disease
aortic arthosclerosis
non- modified risk factors
family history
sex
age
ethnicity
modifiable risk factors
smoking
excersise
diet
DM
CKD
HTN
Dyslipdemia
chronic conditions
inflammation
illicit drugs
poor nutrition
obessity
stress
what is ASCVD
atherosclerotic cadriac disease includes atherosclerosis, coronary arter disease, myocardial infarction and myocardial ischemia
what is the porblem with myocardial remodeling
not as good as intial heart set up so can lead to death
clcinical presenttaion chest pain
crushing, squeezing, or tightness
location: beneath sternum - substernal
may radiate to left arm, jaw should or back or could have atypical presenttaion
evaulkation of risk via what two tools
1/ coronary artery calium (CAC) score
- CT scan to see amount of calcification
- no contrast
- 0 good
- pqrst
-p - precipating or provoking factors, pallitive measure
- q - quality of pain
- r- radiating and region
- s - severity of pian
- t- timing or temporal patterm
stadnard diagnostic test
12- lead ECG
what is a cardiac cath and when is it used
- gold standrad for diagnosisng CAD
- dye involved
0 high risk
diagnosis flow cart
Acute pain - yes - ECG - cardiac cause - yes- STEMI - no - ACS
if not acute - evalute for stable
if not cardiac cause evaulte for other ccauses
if STEMI follow STEMI guidlines
Angina vs STEMI or NSTEMI
Angina - SOB
STEMI or NSTEMI - Diaphoresis, nausea, SOB, vomiting, syncope
Are angina SIHD and ACS symptoms the same?
they can often be indistinguishable
what are some precipitating factors of SIHD
- cold
- exercise
- activity after a large meal
- emotions (anger, anxiety, excitement)
- sexual activity
for SIHD after taking nitro how long till sx relief?
45 seconds to 5 minutes
or may resolve with rest alone
difference between SIHD and ACS
SIHD
- stable plaque obstructs blood flow and there is a mismatch between what’s requires and what the body can provide
ACS
- unatavle plaque rupture causing unpredicatble change in coronary blood flow
compare SIHD and ACS
Duration
Triggers
Relief
Symptoms
SIHD
- 1-15 minutes (variable)
- exercise cold
- nitro and rest
- predictable, stable
ACS
- more then 20 minutes
- can occur at rest
- nitro or rest does not resolve symtpoms
- unpredictable, may worsen with time
***Medical emergency!
Threee principle presenttaion of angina for ACS
Rest angina
- occurs at rest and is more then 20 minutes within 1 week of first presentation
New onset angina
- angina of class III severity with severity onset within 2 months of initial presentation
Increasing angina
- already had angina and is now more frequent and longer
what is vasoplastic angina? Demogrpahic?
- severe pain due to vasospasms in coronary arteries
- may or may not have atherosclerotic disease
- angina at rest that may occur in cycles
- usually for younger patients with or without risk factors
Assement of angina:
Typical angina
Probably angina (possible cardiac origin)
non-cardiac chest pain
Typical angina
- meets all three
1. subteral chest discomfort of characteristic quality and duration
2. provoked by exertion or emtoional stress
3. relief by rest of nitro
Probably angina (possible cardiac origin)
- meets two of three criteria
non-cardiac chest pain
- meets only one or none of criteria
Class of angina
class 1
- ordinary activity does not cause only prolonged strenuous activity that causes
class 2
-slight limitation or normal actity
class 3
-marked limited of normal acity
class 4
- inability to do normal activity
