Chronic Ischemic Heart Disease Flashcards
1
Q
What are causes of Angina?
A
- demand is increased: coronary artery unable to deliver adequate flow because of fixed obstrucction is present (exertional angina, emotional upset derived angina)
- demand is normal supply decreased because a primary event occurs in the artery system (large artery spasm, plaque rupture, microvascular plugging)
2
Q
- Chesst pain that is squeezing, grip like, suffocating, heavy but not sharp, stabbing or related to breathing
- levine sign
- alternate: pressure, tightness, heavy
- some are atypical: nausea, burning or atypical location, or even sharp
- women more likely atypical
A
Angina
3
Q
what are other cardiac conditions that may intensify ischemia?
A
- Anemia
- Fever and infection
- tachyarrhythmias
- emotional stress
- hypoxemia
4
Q
Initial lab tests for Angina?
A
- CBC, lytes, BUN and creatinine
- UA for analysis of glucose and microalbuminuria
- fasting glucose or A1c
- fasting lipid panel
- resting ECG
- CXR when signs or symptoms of cardiac or pulmonary disease are presetn
- resting ECHO (when a systolic murmur or CHF is present or when active pain is present)
5
Q
What are indications for Angiography?
A
- CCS class III OR IV angina
- high risk results of noninvasive stress testing
- sudden death or ventricular arrhythmia with angina
- angian and signs of CHF
- clinical findings suggesting severe CAD
- EF < 50% by noninvasive imaging and angina
- patients with inconclusive noninvasive testing and angina
6
Q
- Reduces short and long term odds of MI in pts with unstable angina
- 33% reduction in patients with stable angina
- ASA and clopidogrel of often used in this type of therapy
A
CAD: antiplatelet therapy
7
Q
for is recommended for secondary prevention?
A
- Lipid lowering angents
- lifestyle changes, diet changes, agressive lipid lowering with statins
- LDL should be lowered to < 70
8
Q
- Effective in blunting HR, BP and contractility and thus reduce oxygen consumption during stress or exercise
- effective as first line therapy in control of exertional angina
- effective in reducing post MI mortality up to 3yrs posst MI
- use for long term in pts with LVEF < 40%
- titrate to resting HR of 55-60
- contraindicated in asthma, COPD, severe bradycardia, SSS
- fatigue, depression, nightmares, impotece are side effect
A
CAD: Beta blockers
9
Q
- Inhibit transmembrane calcium flux across different types of channels
- generally recommended as an alternative to beta blockers or to be used in combo
- all have some negative inotropic effects
- of equal efficacy to BBs for angina relief
- better for vasospastic angina
- short acting forms not recommended
- side effects: CHF, edema, hypotension, constipation
A
calcium channel blockers
10
Q
- Endothelium independent vasodilators that lower oxygen and demand and increase perfusion
- effective in reducing exertional angina but can cause reflex tachycardia
- work well in combination with BB
- tolerance develoops rapidly without daily nitrate free intervals
- headache most common side effect
- cannot be used within 24 hours of sildenafil use
- ALL CAD pts should be instructed in the use
A
Nitrates for CAD
11
Q
- MOA is not certain
- alternative to standard therapy
- studies performed are with the drug as an add on to at least one conventional anti-anginal agent
- in these studies there was improved exercise time, reduced episodes of angina and decreased use of NTG
A
Ranlozine
12
Q
Indications for revascularization for chronic stable angina?
A
CABG for:
- Left main stenosis
- 3 vessel disease (in patient with reduced LVEF or treated diabetes
- 2 vessel disease with proximal LAD stenosis and LV dysfunction
PTCA or CABG for:
- Various levels of severity of CAD who have angina that cannot be successfully controlled by medication or have high risk noninvasive stress test results
PCI
- Reduces angina
- does not reduce mortality in stable patients vs. medical mangement
- PCI does not lower the long term risk for subsequent MI
13
Q
Pathways to ACS?
A
Spontaneous rupture of coronary plaque
- Rupture to complete vessel occulsion
- rupture to partial occlusion causing narrowing of the lumen
Coronary vasoconstriction
chronic CAD witha supply demand imbalance
14
Q
diagnosis of unstable angina?
A
- New onset angina of less than two months duration that is severe and frequent >3 days
- Crescendo Angina (more frequent, more prolonged, lower threshold)
- rest angina
- initial biomarkers are negative
15
Q
Thearpy for unstable angina for those admitted to the hospital or chest pain center?
A
- assessment of risk
- bed rest
- sedation as needed
- ECG monitoring, serial 12 lead ECGs
- serial evaluation of cardiac biomarkers
- anti-thrombotic (heparin or LMWH)
- antiplatelet agents (dual antiplatelet therapy)
- beta blockers scheduled
- nitrates as needed for pain
