Sketchy Path: Stable Angina, Vasospastic Angina, Acute Coronary Syndromes (VA, NSTEMI, STEMI) Flashcards
Most atheromatous plaques are stable (like the quiet plaques hanging out over the stables), but they can lead to exertional pain with the stenosis is greater than ________.
70% (like the blacksmith with the 70-shaped tongs over the angina anvil having chest pain while working)
Stable angina can lead to damage in what part of the heart?
The subendocardial area (like the red-hot horseshoe that has a dark area in the center, near its lumen)
Stable angina typically improves with _____________.
rest or nitroglycerin (like the happy blacksmith resting against the TNT boxes and popping NO)
Which kind of angina happens more often at night?
Prinzmetal angina (like the guy sleeping –with a night cap –being woken up by a horse pulling on his anvil medal)
Although prinzmetal angina can occur in any vessel, it most often occurs _____________.
over plaques (like the black plaque above the horse waking the stable boy)
True or false: prinzmetal angina does not improve with NO.
False. It does. This makes the differentiation between prinzmetal angina and stable angina very difficult.
(Think of the stable boy who represents prinzmetal angina sleeping on NO boxes.)
How can prinzmetal angina be treated?
With CCBs (like the horses eating calci-yum ice cream)
What are risk factors for prinzmetal angina?
- Sumatriptans (like the angry sumo stable manager)
- Cocaine (like the little kid spilling his cocoa while the sumo guy pulls him away)
- Cigarette smoking (like the sumo man smoking)
True or false: most plaque ruptures lead to MI.
False. Most are subclinical and are repaired.
Think of the stable boy dutifully repairing the broken fence.
When plaques rupture, _____________ fills the lumen.
platelets (like the home PLATE next to the broken fence)
Acute coronary syndrome is caused by ____________ plaques.
unstable plaques (like the plaque that is falling over as the ACS crown horse breaks out of the gate)
Which plaques most often rupture?
It’s not actually predictable. Sometimes small plaques rupture and sometimes seemingly stable plaques rupture.
(It’s like the guy flipping a coin next to the ACS horse –it’s anyone’s guess.)
Unstable angina is caused by _____________ occlusions.
near-complete (like the bucket that is not completely full of hay but is almost there)
What’s the difference between an NSTEMI and a STEMI?
Both are caused by plaque ruptures with thrombus formation (like the two horses knocking plaques off and scattering the thrombus hay everywhere), but NSTEMIs involve less ischemia due to partial occlusions (like the guy with the broken lute string who’s lute is only mostly filled with hay –he’s near the horse that knocked the ST sign over). STEMIs result from full occlusions (like the guy with the fully stuffed lute near the upright ST sign).
NSTEMIs cause partial-thickness infarctions (like the horseshoe with the dark spot near the lumen).
Describe the four stages of ECGs in a STEMI.
1) Broad-based T-waves (like the T weather vane)
2) ST elevation (like the ST sign just beneath the T sign)
3) Q waves (like the Q lasso just beneath the ST sign)
4) T inversion (like the T wave shadow)
