Ischemic Heart Disease Flashcards
risk factors for development of coronary atherosclerosis
hypertension
abnormal lipids
cigarette smoking
diabetes
obesity
family history
male gender
lifestyle factors, such as lack of physical activity and unhealthy diet
increasing age
unstable atherosclerotic plaques
presence of inflammatory cells
thin fibrous cap
few smooth muscle cells
eroded endothelium
activated macrophages
stable atherosclerotic plaques
lack of inflammatory cells
thick fibrous cap
more smooth muscle cells
intact endothelium
foam cells
Levene’s sign
putting hand over chest and squeezing
clinical types of angina
chronic, stable
atypical
anginal equivalents and silent ischemia
atypical angina
angina pectoris that is atypical in location and not strictly related to provokings factors especially in women and diabetic patients
anginal equivalents are symptoms of myocardial ischemia other than angina
dyspnea, nausea, fatigue, and faintness
more common in women, elderly, and diabetic patients
class I angina
ordinary activity does not cause angina - only with strenuous, rapid, or prolonged exertion
class II angina
slight limitation of ordinary activity - such as walking, climbing stairs rapidly, walking uphill, or exertion after meals
cold weather, emotional stress, or during first few hours after awakening
class III angina
marked limitations of ordinary physical activity - angina on walking 1 or 2 blocks on the level or 1 flight of stairs at a normal pace under normal conditions
class IV angina
inability to carry on any physical activity without discomfort or angina at rest
initial treatment of chronic stable angina
A = aspirin and antianginal therapy
B = beta-blocker and blood pressure
C = cigarette smoking and cholesterol
D = diet and diabetes
E = education
goals of therapy for chronic stable ischemia
reudce risk of mortality and CV events - prolong life
reduce symptoms - improve quality of life
ranolazine
reduces myocardial ischemia by closing hte late inward NA+ gate, and thus reducing compensatory Na+/Ca++ exchange
anti-ischemic effects occur in the absence of changes in heart rate or blood pressure
indications for coronary angiography
appearance of angina at rest
concern for underestimating the severity of disease
intolerance of medications
repeate stress test becoming positive in the first stage
indications for myocardial revascularization
failure of medical therapy
intolerable side effects from medical therapy
compelling anatomy
AP-associated severe cardiac dysfunction
