Myocardial Ischemia Flashcards
How long does angina usually last?
less than 30 min.
How long does angina usually last?
What is charicteristic of Onset of angina?
usually gradual
Relieved by stopping activity
or medication
worsened by inc work or lying down
Why is Angina sometimes worse when you lie down?
Increases Pre-load(venous return, oxygen demand, etc
What testing can you do to test for Myocardial ischemia?
Resting ECG Basic labs -lipid panel -basic chemistries Exercise stress test Echocardiography
What is stress testing used for?
Diagnosing Atypical chest dyscomfort Prognosis: Stable Angina Post-MI Post-revascularization
What are the protocols for exercise stress testing?
Treadmill graded level of exertion
exercise to 85% predicted max HR for age
How is stress test interpreted?
ST segment shift ST depression-subendocardial ST elevation- full thickness ischemia Devt of symptoms Devt of ventricular dysrhythmia
How is stress test interpreted?
ST segment shift ST depression-subendocardial ST elevation- full thickness ischemia Devt of symptoms Devt of ventricular dysrhythmia
What is charicteristic of Onset of angina?
usually gradual
Relieved by stopping activity
or medication
worsened by inc work or lying down
Why is Angina sometimes worse when you lie down?
Increases Pre-load(venous return, oxygen demand, etc
What testing can you do to test for Myocardial ischemia?
Resting ECG Basic labs -lipid panel -basic chemistries Exercise stress test Echocardiography
What is stress testing used for?
Diagnosing Atypical chest dyscomfort Prognosis: Stable Angina Post-MI Post-revascularization
What are the protocols for exercise stress testing?
Treadmill graded level of exertion
exercise to 85% predicted max HR for age
What is used for pharmacological stress testing?
Used when exercise impracticalor not possible Adenosine, dipyridamole -Vasodilator, incr. HR and work Dobutamine -incr. contractility=inc O2 demand
How is stress test interpreted?
ST segment shift ST depression-subendocardial ST elevation- full thickness ischemia Devt of symptoms Devt of ventricular dysrhythmia
What causes irreversible injury/infarction?
Depletion of ATP. Not replaced
Ca2+ overload
Catabolite Accumulation
How can infarction be prevented/reduced?
Increase oxygen supply -reperfusion -coronary vasodilation Decreased O2 demand -Beta Blockers decreased BP Reduce Preload Reduce circ catecholamines
Drugs used to treat Myocardial Ischemia
Nitrates
Beta Blockers
Calcium Antagonists
What effect do Beta Blockers have on Ischemia?
.
What effect do Nitrates have on Ischemia?
.
What effect do Calcium Antagonists have on Ischemia?
.
What is Ischemia?
Reduced tissue perfusion?
What is Coronary angina at rest?
Prinzmetal Angina.
What is the basic cause of ischemia?
INcreased Demand
Decresed Supply
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
What else can mimic Ischemic Pain?
Esophageal spasm
Aortic Dissection
Pericardial Disease(Sharp pain, positional)
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)
