ischemic heart dz Flashcards
2 general causes of angina
- demand is increased but theres inadequate flow d/t fixed obstruction (exertional angina, emotional upset angina)
- demand is normal but supply decreased bc of a primary event
insufficient oxygen to supply the cardiac muscle
ischemia
pain/pressure caused by ischemia
angina
squeezing, grip like, suffocating heavy chest pain but NOT sharp or related to breathing; levine sign
typican angina
fist to chest d/t pain is what
levine sign
fist to chest d/t pain is what
levine sign
which group is more likely to feel atypical angina and what is that?
- women more likely
- no pain but nausea, burning, atypical location
things that may intensify ischemia
- anemia
- fever & infection
- tachyarrhythmiaas
- emotional stress
- hypoxemia
sx of acute myocardial ischemia secondary to acute plaque rupture & carrying degrees of coronary artery thrombosis (occlusion)
ACS
two ACS conditions of subtotal occlusion with ST depression &/or T wave inversions
UA, NSTEMI
positive cardiac enzymes is seen in which ACS conditions?
NSTEMI and STEMI
condition of total occlusion with ST elevation
STEMI
most common cause of MI
atherosclerosis
chest pain at rest with ACS indicates what level of occlusion
> 90%
how does ECG progress with STEMI
- hyperacute T waves
- ST elevations
- pathologic Q wave
4 populations that troponin may be FALSELY elevated in
- renal failure
- advanced heart failure
- acute PE
- CVA
what is OANM
- oxygen
- aspirin 325mg chewed
- Nitroglycerin sublinual
- Morphine IV NTG
what test can be done to differntiate btwn UA and NSTEMI if you see ST depression &/or T wave inversion on ECG
cardiac enzymes
* will be + in NSTEMI and - in UA
medication for cocaine related ACS
BZD for sx
standard therapies (aspirin, nitro)
which class of med should be avoided in cocaine related ACS
beta blocker
new onset severe chest pain < 2 month that is frequent (> 3x/day) should make you think of
unstable angina
ischemic sx of ACS, negative cardiac markers +/- ECG ischemic changes
unstable angina
most common cause of unstable angina
plaque rupture causing incomplete coronary artery stenosis
angina is unstable if it has any of these 3 things
- rest angina lasting more than 20-30 mins
- new onset angina
- change in angina pattern
what type of MI: type 1 or 2
spontaneous MI
* plaque rupture/erosion w/ occlusive or non-occlusive thrombus
type 1 MI
what type of MI: type 1 or 2
something else triggers the problem (pneumonia, emotional upset, etc)
* atherosclerosis & oxygen supply/demand imbalance
* vasospasm or corooary microvascular dysfunction
* non-atherosclerotic coronary dissection
* o2 supply/demand imbalance alone
Type 2
- reduces events for pt w/ stabile angina
- reduces short & long term odds of MI in Unstable angina
antiplatelet therapy
what medication can be used if pt is intolerant to ASA but antiplatelet therapy is indicated
clopidogrel
beta blockers are good as first line for control of ____ angina
exertional
CCB of equal efficacy too
CCBs are mainstay therapy for ____ angina
vasospastic/Prinzmetal
____ is effective in reducing exertional angina but can cause reflex tachycardia; works well with BB
nitrates
unstable angina tx for admitted patients (3)
- dual antiplatelets– Aspirin + P2Y12 receptor antagonist (Clopidrogrel)
- anticoagulant– heparin
- BB scheduled & nitrates PRN
name the worst risk factor and also the most important modifiable risk factor for angina pectoris/stable angina
- DM– worst risk factor
- smoking– most modifiable risk factor
substernal/retrosternal chest pain/discomfort that is poorly localized, exertional, short in duration; worse w/ activity and relieved with rest or nitroglycerin
angina pectoris/stable angina
3 tests used in diagnosing stable angina
- ECG
- stress testing
- coronary angiography
most important noninvasive testing used in diagnosing stable angina
stress testing
definitive diagnostic test for stable angina that defines location and extent of CAD
coronary angiography
4 drugs used in secondary prevention tx regimen
- aspirin + BB
- sublingual nitroglycerin PRN
- daily statin
should also reduce risk factors like HTN, DM, smoking, diet/exercise
definitive management of stable angina (2)
- percutaneous transluminal coronary angioplasty (PCTA)
- coronary artery bypass graft
both are “revascularization”
angina pectoris
which revascularization procedure is used with 1 or 2 vessel dz in non-DM not invoving left main coronary artery & w/ normal ejection fraction
PTCA
which revascularization is used with left main coronary artery stenosis, 3 vessel dz or w/ 2 for DM, ejection fraction < 40%
coronary artery bypass graft
when can you give morphine IV in patient w/ MI
when pain isnt responding to nitro
pt w/ MI but w/o shock, pulmonary congestion or bradycardia should get what adjuctive tx?
IV BB
pt w/ MI + bradycardia complications involving AV and sinus node should get what ?
atropine
early complications of MI (5)
- v. fib
- ventricular aneurysm
- cardiogenic shock
- heart failure
- LV wall rupture
____ reduces angina but does not reduce mortality in stable patients compared to medical manage; does not lower long term risk for subsequent MI
PCI (PTCA)
**best **w/in 3hrs of sx onset & superior to thrombolytics in tx of STEMI
PCI (PCTA)
reperfusion via PCI or thrombolytics is best done w/in ____ of sx onset or if ongoing chest pain
12 hrs
used when theres > 120 min delay from FMC to primary PCI or if PCI is not an option
fibrinolytic therapy
what is the difference between antithrombotics and thrombolytics (fibrinolytics)
- antithrombotics prevent new clots, the other dissolves them
Spontaneous episodes of angina accompanied by transient ECG ischemic ST changes d/t epicardial coronary artery vasospasm, leading to transient myocardial ischemia
vasospastic/prinzmetals angina
coronary artery vasospasm causing ST segment elevation & transmural ischemia; **endothelial dysfunction **
pathophys of vasospastic angina
name 3 triggers of vasospastic angina
- cold weather
- alpha-agonists
- hyperventilation
Chest pain mainly at rest usually not triggered by exertion nor relieved with rest in younger patient w/ few or no CV risk factors; episodes last 5-15mins
vasospastic angina
likely condition?
- ECG shows Transient ST elevations in pattern of affected artery that resolve w/ sx resolution
- Angiography r/o CAD & has no evidence of high grade stenosis
vasospastic angina
this is used to treat what?
- no smoking
- CCB
- SL nitroglycerin PRN
vasospastic angina
