Myocardial Ischemia Flashcards

1
Q

How long does angina usually last?

A

less than 30 min.

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2
Q

How long does angina usually last?

A
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3
Q

What is charicteristic of Onset of angina?

A

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

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4
Q

Why is Angina sometimes worse when you lie down?

A

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

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5
Q

What testing can you do to test for Myocardial ischemia?

A
Resting ECG
Basic labs
-lipid panel
-basic chemistries
Exercise stress test
Echocardiography
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6
Q

What is stress testing used for?

A
Diagnosing Atypical chest dyscomfort
Prognosis:
Stable Angina
Post-MI
Post-revascularization
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7
Q

What are the protocols for exercise stress testing?

A

Treadmill graded level of exertion

exercise to 85% predicted max HR for age

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8
Q

How is stress test interpreted?

A
ST segment shift
ST depression-subendocardial
ST elevation- full thickness ischemia
Devt of symptoms
Devt of ventricular dysrhythmia
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9
Q

How is stress test interpreted?

A
ST segment shift
ST depression-subendocardial
ST elevation- full thickness ischemia
Devt of symptoms
Devt of ventricular dysrhythmia
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10
Q

What is charicteristic of Onset of angina?

A

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

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11
Q

Why is Angina sometimes worse when you lie down?

A

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

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12
Q

What testing can you do to test for Myocardial ischemia?

A
Resting ECG
Basic labs
-lipid panel
-basic chemistries
Exercise stress test
Echocardiography
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13
Q

What is stress testing used for?

A
Diagnosing Atypical chest dyscomfort
Prognosis:
Stable Angina
Post-MI
Post-revascularization
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14
Q

What are the protocols for exercise stress testing?

A

Treadmill graded level of exertion

exercise to 85% predicted max HR for age

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15
Q

What is used for pharmacological stress testing?

A
Used when exercise impracticalor not possible
Adenosine, dipyridamole
-Vasodilator, incr. HR and work
Dobutamine
-incr. contractility=inc O2 demand
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16
Q

How is stress test interpreted?

A
ST segment shift
ST depression-subendocardial
ST elevation- full thickness ischemia
Devt of symptoms
Devt of ventricular dysrhythmia
17
Q

What causes irreversible injury/infarction?

A

Depletion of ATP. Not replaced
Ca2+ overload
Catabolite Accumulation

18
Q

How can infarction be prevented/reduced?

A
Increase oxygen supply
-reperfusion
-coronary vasodilation
Decreased O2 demand
-Beta Blockers
decreased BP
Reduce Preload
Reduce circ catecholamines
19
Q

Drugs used to treat Myocardial Ischemia

A

Nitrates
Beta Blockers
Calcium Antagonists

20
Q

What effect do Beta Blockers have on Ischemia?

21
Q

What effect do Nitrates have on Ischemia?

22
Q

What effect do Calcium Antagonists have on Ischemia?

23
Q

What is Ischemia?

A

Reduced tissue perfusion?

24
Q

What is Coronary angina at rest?

A

Prinzmetal Angina.

25
What is the basic cause of ischemia?
INcreased Demand | Decresed Supply
26
What is the Clinical presentation of Myocardial Ischemia?
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
27
What else can mimic Ischemic Pain?
Esophageal spasm Aortic Dissection Pericardial Disease(Sharp pain, positional)
28
What are the different types of angina?
``` 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) ```