S2 L2.2: Angina Flashcards
Pain coming from the heart
Angina
Pain over the chest
Pectoris
Is essentially defined as chest pain
Angina Pectoris
T/F: Chest pain can also be felt on the arm because nerves of heart and arm fall into the same nucleus
True
What do you call the type of pain that may be referred to the left shoulder, neck, jaw, or between shoulder blades?
Ischemic pain
T/F: Angina Pectoris is a superficial visceral pressure pr squeezing sensation
False. It is a DEEP visceral pressure or squeezing sensation
T/F: Angina Pectoris is difficult to locate because it is not skin-deep
True
T/F regarding angina pectoris:
- Some describe it as tightness, heaviness, and so,e say there is radiation to the back
- Some diabetics experience it in stomach
- Sometimes mistaken for hyperacidity but it is already a heart attack
- Should not be interpreted as heart attack but as a symptom of a possible heart attack
- Almost always at the back or epigastrium; at times, substernal
1 - 4: True
5. False because angina pectoris is almost always substernal; at times, at the back or epigastrium
Give me the three (3) possible locations that the pain of angina pectoris can radiate to
jaw, neck or arm; typically the ulnar sirface of left arm
How many minutes does angina usually occur?
2 - 30 mins. It is typically transient
T/F Regarding Angina Pectoris:
- Precipitated by exertion, emotional upset or other events
that increase myocardial oxygen demand (tachycardia or HTN) - Relieved by rest or cessation of triggering event and
nitrates - Beyond 30 mins it can already be a heart attack
- May radiate to neck, shoulder, arm
- T
- T
- T
- T
T/F:
Anything that increase myocardial oxygen demands either through physical or emotional/ psychological means as long as there’s bradycardia or blood pressure goes down may indicate angina pectoris which may lead to a heart attack
False
Anything that increase myocardial oxygen demands either through physical or emotional/ psychological means as long as there’s TACHYCARDIA or blood pressure goes UP may indicate angina pectoris which may lead to a heart attack
What is the theory of convergence?
Chest pain coming from the heart can also be
felt in the arm because the nerves that supply
the heart and arm end up on the same nucleus
in the dorsal column of the spinal cord
What is defined as not typically the chest heaviness, tightness, or squeezing
pain?
Anginal Equivalents
Give me the five (5) symptoms of anginal equivalents that are usually in the elderly and diabetics
○ Dyspnea
○ Faintness
○ Fatigue
○ Eructation
■ “Empacho” or indigestion feeling
○ Epigastric pain
T/F:
It is okay to sometimes disregard the symptoms of anginal equivalents as these do not usually lead to heart attack
False.
Very important not to disregard these symptoms as these
may lead to heart attack
Give me at least (5) symptoms that are unlikely anginal
● Pleuritic pain
● Primary or sole location of discomfort in the middle or
lower abdominal region; if pt can localize if left or right,
the pain is most likely not d/t the heart
● Pain that may be localized at the tip of one finger,
particularly over the left ventricular apex
● Pain reproduced with movement or palpation of the chest
wall or arms
● Constant pain that persists for many hours
● Very brief episodes of pain that last a few seconds or
less (fleeting pain)
● Pain that radiates into the lower extremities, higher than
the jaw or lower than the umbilicus
● Tenderness upon palpation may indicate musculoskeletal
problem
● Pain persists for hours
SYMPTOMS UNLIKELY ANGINAL
What symptom is described in the following??
Sharp or knife-like pain brought on by
respiratory movements or cough d/t inflammation on
pleural space
Pleuritic pain
The following are symptoms that are unlikely anginal, EXCEPT:
A. Primary or sole location of discomfort in the middle or
lower abdominal region; if pt can localize if left or right,
the pain is most likely not d/t the heart
B. Pain that may be localized at the tip of one finger,
particularly over the left ventricular apex
C. Pain persists for hours
D. Tenderness upon palpation may indicate musculoskeletal
problem
E. None of the above
E
Select the letters that are symptoms that are unlikely anginal
A. Constant pain that persists for many hours
B. Deep visceral pressure or squeezing sensation
C. Very brief episodes of pain that last a few seconds or
less (fleeting pain)
D. Precipitated by exertion
E. Pain that radiates into the lower extremities, higher than
the jaw or lower than the umbilicus
A, C, E
B and D are symptoms of angina pectoris
T/F regarding symptoms unlikely anginal:
- Pain reproduced with movement or palpation of the chest or arms may be musculoskeletal
- If pain is fleeting, it is possibly cuased by a muscle
- True. Because if it’s angina the
pain should be present regardless movement or
position - True. If it’s the heart it is usually in a crescendo (pain goes
higher) manner as you go on with your activity
(physically or emotionally)
Give me the six (6) differential diagnosis if pain is RETROSTERNAL
- Myocardial ischemic pain
- Pericardial pain
- Esophageal pain
- Aortic dissection
- Mediastinal lesions
- Pulmonary embolization
Give me the four (4) differential diagnosis if pain is INTERSCAPULAR
- Myocardial ischemic pain
- Musculoskeletal pain
- Gallbladder pain
- Pancreatic pain
Give me the three (3) differential daignosis if pain is in the ARMS
- Myocardial ischemic pain
- Cervical/dorsal spine pain
- Thoracic outlet syndrome
The following are differential diagnosis if pain is in the right anterior chest, EXCEPT:
A. Gallbladder pain
B. Distention of the liver
C. Subdiaphragmatic abscess
D. Pneumonia/pleurisy
E. Injuries
F. None of the Above
F.
The following are the rest of the differential diagnosis if pain is in the RIGHT ANTERIOR CHEST:
- Gastric or duodenal penetrating ulcer
- Pulmonary embolizaation
- Acute myosistis
Give me the seven (7) differential diagnoses if the pain is felt in the SHOULDER
- Myocardial ischemic pain
- Pericarditis
- Subdiaphragmatic abcess
- Diaphragmatic pleurisy
- Cervical spine disease
- Acute musculoskeletal pain
- Thoracic outlet syndrome
Select the letters that are included in the differential diagnosis if the pain is in the EPIGASTRIC region:
A. Myocardial ischemic pain
B. Pericardial pain
C. Esophageal pain
D. Duodenal/gastric pain
E. Pancreatic pain
F. Galbladder pain
G. Distention of the liver
H. Diaphragmatic pleurisy
I. Pneumonia
All are included
Give me the nine (9) differential diagnoses if the pain is felt in the LEFT LOWER ANTERIOR CHEST
- Intercostal neuralgia
- Pulmonary embolization
- Myositis
- Pneumonia/pleurisy
- Splenic infarction
- Splenic flexure syndrome
- Subdiaphragmatic abscess
- Precordial catch syndrome
- Injuries
Match the following items regarding TYPES OF THRESHOLDS:
- Patient can predict what level produce angina
- There are good days and bad days because it is unpredictable
- Postprandial usually high carbohydrate
- Tricky for HCPs since pt may have varied answers
each time you ask them if they feel chest pain upon
climbing the stairs since they may change the level
of the activity as they are able to predict what level of
exertion causes the angina.
A. Fixed threshold Angina
B. Variable-threshold Angina
C. MIxed Angina
- A
- B
- B
■ Can also happen after a big meal
■ Small circulation going into the splanchnic area
bc need to digest a lot of food and that stills
blood away from the heart
■ If the heart is already diseased, there’s
narrowing of the arteries and taking blood away
from the heart will cause angina
- A
Match the following items regarding TYPES OF THRESHOLD:
- Constant level of activity that causes angina
- More difficult to manage but easier to identify by doctors
- Between fixed and variable
- Circadian variation in angina usually in AM
- Pt can prevent the
occurrence of chest pain because they know at what
level of activity the onset of angina begins
A. Fixed threshold Angina
B. Variable-threshold Angina
C. MIxed Angina
- A
- B
- C
- B
- A. Thus, patients will adjust their level of activity to not feel the angina
T/F Regarding Variable Angina:
- In the variable angina, it could happen at any time of the day
- If you’re about to wake up in the morning,
catecholamines increase and that would be a
time when a diseased heart is more prone to
develop angina, heart attack, or stroke due to
the catecholamine surge - We do not advice high carbohydrate or calorie intake for heart diseased patients
- False. This kind of threshold coincides with the circadian rhythm of catecholamines
As we go on along the day, we need the
catecholamines to start our day but in the
afternoon or as we end the day, catecholamines
decrease and it’s high time for us to rest
- True
- True
ANGINA GRADING
What class is this? and according to what classification?
Patients have cardiac disease
but without the resulting
limitations of physical activity.
Ordinary physical activity does
not cause undue fatigue,
palpitation, dyspnea, or
anginal pain.
Class 1 of New York Heart Association
Functional Classification
ANGINA GRADING
What class is this? and according to what classification?
Inability to carry on any
physical activity without
discomfort
- anginal
syndrome may be present at
rest
Class 4 of Canadian Cardiovascular
Society Functional
Classification
ANGINA GRADING
What class is this? and according to what classification?
Patients have cardiac disease
resulting in slight limitation of
physical activity. They are
comfortable at rest. Ordinary
physical activity results in
fatigue, palpitation, dyspnea,
or anginal pain.
Class 2 of New York Heart Association
Functional Classification
ANGINA GRADING
What class is this? and according to what classification?
Marked limitation of ordinary
physical activity. Walking one
to two blocks on the level and
climbing more than one flight
of stairs in normal conditions.
Class 3 of Canadian Cardiovascular
Society Functional
Classification
ANGINA GRADING
What class is this? and according to what classification?
Slight limitation of ordinary
activity. Walking or climbing
stairs rapidly, walking uphill,
walking or stair climbing after
meals, in cold, or when under
emotional stress or only during
the few hours after awakening.
Walking more than two blocks
on the level and climbing more
than one flight of stairs at a
normal pace and in normal
conditions.
Class 2 of Canadian Cardiovascular
Society Functional
Classification
ANGINA GRADING
What class is this? and according to what classification?
Patients have cardiac disease
resulting in marked limitation
of physical activity. They are
comfortable at rest. Less than
ordinary physical activity
causes fatigue, palpitation,
dyspnea, or anginal pain.
Class 3 of New York Heart Association
Functional Classification
ANGINA GRADING
What class is this? and according to what classification?
Ordinary physical activity,
such as walking and climbing
stairs, does not cause angina.
Angina present with strenuous
or rapid or prolonged exertion
at work or recreation.
Class 1 of Canadian Cardiovascular
Society Functional
Classification
ANGINA GRADING
What class is this? and according to what classification?
Patients have cardiac disease
resulting in inability to carry on
any physical activity without
discomfort. Symptoms of
cardiac insufficiency or of the
anginal syndrome may be
present even at rest. If any
physical activity is undertaken,
discomfort is increased
Class 4 of New York Heart Association
Functional Classification
T/F regarding angina grading:
- New York Heart Association Functional Classification can also be used for patients with heart failure
- New York Heart Association Functional Classification - usually use this for angina and chest pain
- Regarding Class 3 of Canadian Cardiovascular Society Functional Classification : Even brushing your teeth or turning on bed. Need to see the doctor
ASAP, bc might suffer from a heart attack or you might never recover
from it alive - NYHA Class 3 = obstruction present in the coronary artery at about
>50% or 80% - NYHA Class IV = needs hospitalization; can die easily from coughing
or standing up
- T
- F. Canadian Cardiovascular
Society Functional
Classification - usually use this for angina and chest pain - Regarding Class 4 of Canadian Cardiovascular Society Functional Classification : Even brushing your teeth or turning on bed. Need to see the doctor
ASAP, bc might suffer from a heart attack or you might never recover
from it alive
4 - 5 True
