Myocardial Ischemia

Question 1

How long does angina usually last?

Answer 1

less than 30 min.

Question 2

How long does angina usually last?

Question 3

What is charicteristic of Onset of angina?

Answer 3

usually gradual
Relieved by stopping activity
or medication
worsened by inc work or lying down

Question 4

Why is Angina sometimes worse when you lie down?

Answer 4

Increases Pre-load(venous return, oxygen demand, etc

Question 5

What testing can you do to test for Myocardial ischemia?

Answer 5

Resting ECG
Basic labs
-lipid panel
-basic chemistries
Exercise stress test
Echocardiography

Question 6

What is stress testing used for?

Answer 6

Diagnosing Atypical chest dyscomfort
Prognosis:
Stable Angina
Post-MI
Post-revascularization

Question 7

What are the protocols for exercise stress testing?

Answer 7

Treadmill graded level of exertion

exercise to 85% predicted max HR for age

Question 8

How is stress test interpreted?

Answer 8

ST segment shift
ST depression-subendocardial
ST elevation- full thickness ischemia
Devt of symptoms
Devt of ventricular dysrhythmia

Question 9

How is stress test interpreted?

Answer 9

ST segment shift
ST depression-subendocardial
ST elevation- full thickness ischemia
Devt of symptoms
Devt of ventricular dysrhythmia

Question 10

What is charicteristic of Onset of angina?

Answer 10

usually gradual
Relieved by stopping activity
or medication
worsened by inc work or lying down

Question 11

Why is Angina sometimes worse when you lie down?

Answer 11

Increases Pre-load(venous return, oxygen demand, etc

Question 12

What testing can you do to test for Myocardial ischemia?

Answer 12

Resting ECG
Basic labs
-lipid panel
-basic chemistries
Exercise stress test
Echocardiography

Question 13

What is stress testing used for?

Answer 13

Diagnosing Atypical chest dyscomfort
Prognosis:
Stable Angina
Post-MI
Post-revascularization

Question 14

What are the protocols for exercise stress testing?

Answer 14

Treadmill graded level of exertion

exercise to 85% predicted max HR for age

Question 15

What is used for pharmacological stress testing?

Answer 15

Used when exercise impracticalor not possible
Adenosine, dipyridamole
-Vasodilator, incr. HR and work
Dobutamine
-incr. contractility=inc O2 demand

Question 16

How is stress test interpreted?

Answer 16

ST segment shift
ST depression-subendocardial
ST elevation- full thickness ischemia
Devt of symptoms
Devt of ventricular dysrhythmia

Question 17

What causes irreversible injury/infarction?

Answer 17

Depletion of ATP. Not replaced
Ca2+ overload
Catabolite Accumulation

Question 18

How can infarction be prevented/reduced?

Answer 18

Increase oxygen supply
-reperfusion
-coronary vasodilation
Decreased O2 demand
-Beta Blockers
decreased BP
Reduce Preload
Reduce circ catecholamines

Question 19

Drugs used to treat Myocardial Ischemia

Answer 19

Nitrates
Beta Blockers
Calcium Antagonists

Question 20

What effect do Beta Blockers have on Ischemia?

Answer 20

.

Question 21

What effect do Nitrates have on Ischemia?

Answer 21

.

Question 22

What effect do Calcium Antagonists have on Ischemia?

Answer 22

.

Question 23

What is Ischemia?

Answer 23

Reduced tissue perfusion?

Question 24

What is Coronary angina at rest?

Answer 24

Prinzmetal Angina.

Question 25

What is the basic cause of ischemia?

Answer 25

INcreased Demand

Decresed Supply

Question 26

What is the Clinical presentation of Myocardial Ischemia?

Answer 26

Chest Discomfort(Pressure, tightness, Feel like you have to burp)
Exertional
Nausea(same innervation as the stomach) or other GI symptoms
Radiation to shoulder or Jaw
Esophageal spasm can mimic Myocardial ischemia

Question 27

What else can mimic Ischemic Pain?

Answer 27

Esophageal spasm
Aortic Dissection
Pericardial Disease(Sharp pain, positional)

Question 28

What are the different types of angina?

Answer 28

Angina Pectoris: Heavy, pressure, band-like, crushing
Stable Angina: same pattern each time
Unstable angina: New onset
Subjectively worse discomfort
Onset with less activity
Angina at rest(decubitis)