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Question 1

Define Angina

Answer 1

• Inability of narrowed atherosclerotic coronary artery to supply oxygen to the heart muscle under conditions of increased myocardial oxygen demand

–> irreversible cell death occurs

Question 2

compare/contrast stable and unstable angina

Answer 2

• stable = exertional angina resulting from flow limiting coronary stenosis
• Unstable = plaque rupture and thrombus formation (may result in MI)

–> new onset, crescendo, may occur at rest

Question 3

define Unstable angina

Answer 3

• small plaque erosiion may reduce coronary blood flow
• may have transient episodes of angina at rest
• will not cause elevated biomarkers

Question 4

define NSTEMI

Answer 4

non-ST elevation myocardial infarction

• More severe plaque damage with more persistent thrombotic occlusion, the distal territory may be supplied by collaterals
• biomarkers elevated

Question 5

Define STEMI

Answer 5

ST elevation MI

• larger plaque damage results in fixed persistent thrombus and cessation of myocardial perfusion –> resulting tarnsmural necrosis
• biomarkers elevated

Question 6

Women presentation of ischemia

Answer 6

• More likely to present with angina than with acute MI
• Are 5-10 years older at time of presentation
• more likely to have ATYPICAL symptoms
• higher incidence of vasospastic angina
• Higher treadmill stress test false positive

Question 7

describe cardiac enzymes

Answer 7

• Troponins = cardiac regulatory proteins that work with actin and myosin (most sensitive marker)
• Creatinine kinase exists as Isoenzymes with M and B chains (MM, MB, BB)

–> higher percentage of MB fraction in the heart!!!

–> Total Creatine kinase (CK) and CK-MB isoenzyme rise several hours AFER the acute event and peak at 24 hrs

–> HIGH SPECIFICITY FOR CARDIAC TISSUE

–> USEFUL TO ELEVATE FOR RE-INFARCTIONS

Question 8

Troponin

Answer 8

• Troponin levels may not rise for up to 6 hours after the onset of symptoms, the measurement should be repeated if the initial troponins are negative at 6 hours
• Troponin levels may not rise for up to 6 hours after the onset of symptoms, the measurement should be repeated if the initial troponins are negative at 6 hours
• Get serial troponins

Question 9

describe medical therapy for NSTEMI

Answer 9

• ASA (antiplatelet agents), oxygen,
• B-blockers = Lower HR and BP, decrease dysrhythmia, decrease myocardial oxygen demand (contra if hypotensive, bradycardic, decompensated LV failure)
• Nitro = reduces myocardial oxygen demand/increase myocardial oxygen supply

Question 10

TX for STEMI

Answer 10

• THROMBOLYSIS ONLY FOR StEMI
• Percutaneous coronary intervention (need a cath lab)