Ischemic Heart Disease, Angina, Unstable Angina Flashcards
Characterized by insufficient oxygen supply to cardiac muscle, resulting in angina pectoris
Ischemic heart disease
usually occurs when there is an imbalance between myocardial oxygen supply and demand
What most commonly causes ischemic heart disease?
Atherosclerotic narrowing of coronary arteries.
Less often, but sometimes, cause by constriction of coronary arteries (vasospasm - cocaine use)
Rare causes of ischemic heart disease
Congenital abnormalities
Emboli
Arteritis
Dissection
Diagnostic criteria of Metabolic Disease
3 or more of the following:
- Abdominal obesity
- triglycerides > 150mg/dL
- HDL < 40mg/dL men <50mg/dL women
- Fasting glucose >110mg/dL
- HTN
Patients with cerebrovascular disease, peripheral arterial disease, abdominal aortic aneurysm, chronic or end stage renal, or diabetes are considered HIGH risk for what?
Ischemic heart disease
Characterized by paroxysmal chest “squeezing” or pressure, often with sensation of smothering and fear of impending death
Angina
Prinzmetal (variant) angina?
Caused by vasospasm at rest, with preservation of exercise capacity
When should a diagnosis other than stable angina be suspected?
If pain is not completely resolved after 3 doses of the patient’s usual sublingual NTG
Consider UA, MI, or other
How often can sublingual NTG be repeated for angina chest pain?
Every 5 minutes, up to 3 times
3 common patterns of presentation for UA
- Angina at rest
- New onset of angina symptoms
- Increasing pattern of pain in previously stable patients
What does the American Heart Association say is the most common presentation of UA?
Angina at rest
When might UA be suspected?
Pain is less responsive to NTG
Pain lasts longer
Pain occurs at rest or with else exertion than previous episodes of angina
“Clenched fist over the sternum, clenched teeth”
Levine sign
Where might pain from angina pectoris radiate?
- Pain is usually midsternal
2. Classically radiates to the left (jaw, shoulders, arms, wrist, back of neck, combo)
Where do women tend to report radiating pain in angina pectoris? (more frequently than men)
Right shoulder and back pain
How long does stable angina usually last?
Less than 3 minutes
Angina lasting more than 30 minutes?
Suggests UA, MI, or other
Most useful and cost-effective, noninvasive test for Ischemic Heart Disease (Angina)
Exercise stress testing
(Or Chemical stress test if patient can’t move well)
EKG before, during, and after stress
What is considered a positive exercise stress test for ischemic heart disease?
ST-segment depression of 1 mm (0.1mV)
The ischemic ST-segment response generally is defined as flat or downsloping depression of the ST segment >0.1 mV below baseline (i.e., the PR segment) and lasting longer than 0.08 s (Fig. 293-1).
Definitive diagnostic procedure - which is rarely used - for ischemic heart disease?
Coronary angiography
Causes more deaths and disability and incurs greater economic costs than any other illness in the developed world
Ischemic Heart Disease
Most common, serious, chronic, life-threatening illness in US
Ischemic Heart Disease
13 million ppl have IHD, >6 million with angina, >7 million with MI
Does Angina pain radiate to trapezius muscles?
No. That is more typical of PERICARDITIS
“Equivalent” symptoms of myocardial ischemia other than angina, which present with elderly and diabetic patients
Dyspnea, nausea, fatigue, faintness
