Oct. 16, 2019 Flashcards
What is the literal meaning of ANGINA PECTORIS?
“Squeezing of chest”
What is ANGINA PECTORIS?
Pain d/t MYOCARDIAL ISCHEMIA
Is ANGINA PECTORIS technically a disease?
Not technically, it is a mnft of CAD, but it does still have its own mnfts
4 reasons that ANGINA may occur?
- ATHEROSCLEROSIS
- THROMBOSIS
- VASOSPASM
- HEMORRHAGE
What is the most common cause of ANGINA PECTORIS? Why?
ATHEROSCLEROSIS because it affects perf, which results in ISCHEMIA
Why might THROMBOSIS cause ISCHEMIA?
Dec B flow = inadeq perf = ISCHEMIA
What is VASOSPASM? Why does it cause ISCHEMIA?
SMOOTH MUSCLE in the VESSEL contracts spontaneously, and locks in CONSTRICTED state, which dec B flow = inadeq perf = ISCHEMIA
T or F:
healthy tissue cannot dilate on command
T
How does ATHERO affect the ability to dilate?
Causes poor to no dilation
What is a mnft of ANGINA?
Chest pain
What is a defining characteristic of STABLE ANGINA?
It involves FIXED PLAQUE
In STABLE ANGINA, how is B flow affected at rest vs on exertion?
At rest, flow is normal
On exertion, flow is impeded = inadeq perf = ISCHEMIA
What words are used to describe ANGINA
Brief and transient
What other factors affect ANGINA?
Cold and stress
How does cold affect ANGINA?
Cold = VASOCON = dec B flow = inadeq perf = ISCHEMIA
What are 2 other names for VARIANT ANGINA?
VASOSPASTIC or PRINZMETAL’s ANGINA
With VARIANT ANGINA, when does pain occur?
Anytime! Rest, exertion, at night, etc.
The ETIOLOGY of VARIANT ANGINA is unclear, but what are the 4 main theories as to why this ANGINA happens?
1) VASOSPASM
2) ENDOTHELIAL dysfx
3) Ca problems
4) SNS dysfx
How might ENDOTHELIAL dysfx contribute to ANGINA?
Perhaps the ENDOTHELIAL tissue is allowing things to move in and out of CARDIAC MUSCLE inappropriately?
How might Ca problems contribute to ANGINA?
Ca causes muscle contraction, so perhaps Ca is building up and causing inappropriate contractions?
What relates ENDOTHELIAL dysfx with Ca problems?
Excess Ca enters d/t ENDO dysfx
How might the SNS be involved in ANGINA?
SNS controls contractions, dysfx could result in abn contractions
T or F:
ECG changes are present in VARIANT ANGINA
T
When reading an ECG, if the abns are d/t ISCHEMIA, the changes to the HEART are…
…permanent
When reading an ECG, if the abns are d/t ANGINA, the changes to the HEART are…
…only brief changes
Inc ANGINA indicates a higher risk for what?
MI
What is a defining characteristic of UNSTABLE ANGINA?
It involves UNSTABLE PLAQUE
What makes up UNSTABLE PLAQUE?
An accum of PLATELETS, FIBRIN, and CELLULAR DEBRIS
Is there and inc or dec of PG in UNSTABLE ANGINA?
Inc PG
What are PGs sometimes referred to as and why?
“local hormones” because they have a different action in many different location in the body
What do PGs do in the vessel when r/t ANGINA?
VASOSPASM
What releases PGs?
PLATELETS
What happens if the PLAQUE is dislodged?
THROMBOSIS
How is the pain from UNSTABLE ANGINA different from other forms of ANGINA?
More prolonged, more severe, present at res/exertion/nocturnal
What do cells do when they are damaged? Why is this a benefit?
They release their contents, this includes PROTEINS which may act as SERUM MARKERS
Are there SERUM MARKERS involved w UNSTABLE ANGINA?
No
If SERUM MARKERS were elevated, what might this indicate for the HEART?
MI, STEMI, NSETMI
MNFTs of UNSTABLE ANGINA:
- Chest pain (mild-severe, transient)
- Squeezing/burning pain that radiates to (usually) L shoulder, upper arm, neck, see pic for more
What is important to remember about chest pain?
Not all chest pain indicates CARDIAC problem
What are Tx options for UNSTABLE ANGINA?
- Cease activity that is causing pain
- Nitro-gylcerin patch
- Prevention by removing risk factors
What effect does smoking have which would be negative for ANGINA?
Smoking causes VASOCON
What is the end stage of CAD?
MI
Is MI considered STEMI or NSTEMI?
It can be either
T or F:
MI has a slow, prolonged onset
F, rapido
What is indicated by “PROXIMAL OCCLUSION”?
A blockage higher on the HEART (closer to the AORTA)
What is indicated by “DISTAL OCCLUSION”?
A blockage lower on the HEART (closer to the APEX)
Is STEMI a complete or partial occlusion of a major A?
Complete occlusion, usually PROX
Are most MIs NSTEMI or STEMI?
STEMI (70%)
Which vessels are the most affected by MI? (3)
1) L ANTERIOR DESCENDING A (40-50%)
2) R CORONARY A (30-40%)
3) L CIRCUMFLEX A (15-20%)
Name 3 causes of MI
1) Severe HEMORRHAGE
2) ATHERO
3) CORONARY A VASOSPASM
What condition is most often the cause of MI?
ATHEROSCLEROSIS bayyybeee (been watching too much of RuPaul’s Drag Race at this point…)
Explain how ATHERO causes MI
Progressive ATHERO = ACUTE ISCHEMIA = HYPOXIA = anaerobic metabolism = buildup of lactic acid = METABOLIC ACIDOSIS = ARRHYTHMIAS, INFARCTION, and HF
What do we call death d/t ISCHEMIA?
INFARCTION
What factors determine the extent of the INFARCT?
- Which V is affected
- Degree of OCCLUSION (complete or partial)
- Duration of blockage
- Cardiac status (eg BP, rhythm)
- Existing COLLATERALS (to compensate)
