Acute Coronary Syndromes

Question 1

Isachemic Syndromes

Answer 1

• Angina Pectoris
• Stable Angina
• Variant Angina
• Unstable Angina
• Silent Ischemia
• Myocardial Infarction

Question 2

Ischemia

Answer 2

• Is a condition of imbalance between myocardial O2 supply and demand often caused by atherosclerosis of the coronary arteries.
• Causes of Increased demand - Exercise, Cold weather (increased vascular resistance), mental/emotional stress, spontaneous changes in HR and BP
• Causes of reduced supply - Impaired aortic driving pressure, increased coronary resistance
• This supply: demand imbalance results in Angina
• Ischemic contracture of myocardium - Insufficient or no ATP delivered to break cross myofilament cross-bridge

Question 3

Determinants of myocardial oxygen supply and demand

Answer 3

• ventricular pressure
• ventricular radius
• ventricular wall thickness

Question 4

Angina

Answer 4

Definition: Chest pain or discomfort caused due to cardiac ischemia

• Heaviness, tightness, pressure
• Discomfort gradually builds
• Gradually subsides
• Episode Lasts (1-15 minutes)
• Often confused with digestive disturbances

Question 5

3 major types of angina

Answer 5

• Stable
• Unstable
• Printzemental

Question 6

Angina- Somatic fiber pain syndrome

Answer 6

Usually easily described, precisely located, and usually experienced as a sharp sensation,

Question 7

Angina- visceral fiber pain syndrome

Answer 7

• internal organs, such as the heart and blood vessels, the esophagus, and the visceral pleura,•enter the spinal cord at multiple levels and
• Map to areas on the parietal cortex corresponding to the cord levels shared with somatic fibers.
• more often described as discomfort, heaviness, or aching.

Question 8

Stable angina

Answer 8

• Discomfort gradually builds
• Occurs with exercise at a predictable and consistent intensity
• Gradually subsides with rest
• Typically Lasts (2-5 minutes) - Rarely more than 5-10 mins
• Improve with nitroglycerin

Question 9

Unstable angina

Answer 9

• Recent or acceleration of angina threshold; New onset < 2 months
• Symptoms at rest > 15-20 minutes.
• Gradually worsens in a crescendo-like pattern
• May not respond to Nitro or Rest
• Often precursor to MI

Question 10

Angina in the elderly

Answer 10

most likely to present with atypical symptoms (SOB. AMS)

Question 11

Angina in diabetics

Answer 11

may not be able to accurately sense or describe pain

Question 12

angina in women

Answer 12

more commonly report nausea, emesis, jaw pain, neck pain, and back pain

Question 13

Myocardial infarction

Answer 13

Cell death in the heart muscle caused by complete and prolonged occlusion of a coronary artery

Question 14

Main factors that increase the likelihood of MI

Answer 14

• associated with exertion
• radiation to left arm
• described as pressure

Question 15

Main factors that decrease likelihood of MI

Answer 15

• described as positional
• described as sharp
• reproducible with palpation
• not associated with exertion

Question 16

Implications for PT in patients with acute syndromes

Answer 16

• Patients should always have with them their NTG during exercise sessions.
• Patients should report symptoms of chest pain and take NTG as directed.
• If symptoms persist 5 mins after NTG, dose can be repeated two more times with 5 min intervals between doses.
• If symptoms persist seek prompt medical attention.
• NTG can be used prophylactically 5-10 mins before activity.
• Physiologic responses to activity should be monitored (HR, BP, RPP)