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Clin Med- P > Angina/NSTEMI > Flashcards

Angina/NSTEMI Flashcards

1
Q

Why do you get angina?

A

supply of O2 doesn’t meet demand

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2
Q

What does angina’s O2 supply/demand imbalance cause? What nervous system mediates this?

A

causes ischemia, frequently with pain (angina)

ANS

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3
Q

What is chronic stable angina?

A

pattern of chest pain that is similar in frequency or severity for longer than 2 months; KEY = pain episodes are provoked by stresses of SIMILIAR intensity

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4
Q

what are the 3 criteria for stable angina?

A

1) . substernal chest pain
2) . exertional chest pain
3) . chest pain relieved with rest

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5
Q

What are the 3 criteria for unstable angina?

A

1) . rest angina

2) . severe angina of new onset 3). increase in severity or frequency of previously stable angina

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6
Q

What coronary artery is frequently occluded & causes an MI? What part of the heart does this affect?

A

LAD- left anterior descending

effects most of left ventricle and contractility

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7
Q

What % of narrowing in a coronary artery can cause angina?

A

50%

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8
Q

what are 3 main body mechanisms that block blood flow and can lead to stable angina

A

atherosclerosis
vasoconstriction/artery spasm
small vessel atherosclerotic disease

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9
Q

What is the common clinical manifestation of stable angina?

A

Levine sign (patient clutching left side of chest)

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10
Q

A patient with stable angina experiences pain with ______

A

exertion

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11
Q

What is another common symptom of angina besides pain?

A

indigestion

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12
Q

What is atypical angina? What percentage range is the pts’ CAD?

A

Meets 2 out the 3 criteria for stable angina

20-50%

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13
Q

What is non-coronary chest pain?

A

when none or only one criteria of stable angina is met

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14
Q

Not all chest pain is _____

A

angina

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15
Q

Don’t determine angina with only a _______

A

physical exam (“even cardiologists are frequently fooled”)

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16
Q

What may appear on an EKG that demonstrates an old MI

A

abnormally large & downward Q wave (ischemic heart muscle diverts conduction around the ischemia)

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17
Q

What types of patients are not indicated for a stress test to dx stable angina?

A

low or high risk

moderate pt best- pt with multiple cardio risk factors & you suspect CAD, then do stress test

18
Q

what are the two most important predictors of survival with chronic CAD pts? what test do you do to evaluate this?

A

left ventricle function
extent of myocardium at risk
ECHO

19
Q

What type of testing can you do in place of a stress test for non-ambulatory or limited exercise capacity pts?

A

pharmacologic stress test (dobutamine, dipyridamole, adenosine)

20
Q

When are invasive tests (angiography/cath) indicated for an anginal patient

A

patient has failed to meet goal of medical therapy and has an inc risk of MI/death

21
Q

What are two critical treatments to maintain stable angina?

A 
lifestyle modifications (Global cardiovascular risk)
pharmacologic therapy
22
Q

How much exercise is good for a patient with stable angina?

A

walk to the point of pain, stop & then walk again

23
Q

What is drug of choice for symptomatic stable angina?

A

Nitrates

24
Q

Besides nitrates, what are the 3 other types of drugs used for stable angina tx?

A

statins (aggressively lower lipids = >50%), BB after MI (control BP), antiplatelet agents
**statins and BB only drugs to reduce morbidity and mortality

25
Q

What is BEST tx for stable angina?

A

medical treatment is better than revascularization PCI or surgery)

26
Q

What are two main questions to ask a patient with stable angina at EVERY office visit? (they are red flag q’s)

A

1) . has there been a change in level of activity since the last visit
2) . have anginal symptoms increased in severity or frequency (distinguish stable vs unstable)

27
Q

what is microvascular angina? when does CP usually occur? What is this also called? What is best tx for it?

A

microvascular dysfunction (vasospasm or plaque in small vessels) but no lesions or spasm in large coronary vessels
CP occurs mostly at rest
“syndrome X”
Tx is unclear but aerobic exercise may help develop collateral circulation**

28
Q

During ACS, what type of angina do you have

A

unstable

29
Q

What are six stages of atherosclerosis?

A

Foam cells, fatty streak, intermediate lesion, atheroma, fibrous plaque, complicated lesion/rupture

30
Q

What stage of atherosclerosis do stable angina signs develop? how about ACS signs?

A

fibrous plaque stage

complicated lesion/rupture

31
Q

Describe what an unstable plaque looks like

A

thin fibrous capsule and liquid lipid core (really thrombogenic)

32
Q

Difference between NSTEMI and unstable angina

A

in unstable angina, the ischemia is not severe enough to elevate cardiac enzymes & cause tissue injury

33
Q

Describe the difference between stable and unstable angina symptoms

A

unstable symptoms are more severe & last longer

stable symptoms lasts about 2-3 minutes and returns to normal

34
Q

What is a key thing to ask the patient about his/her anginal symptoms?

A

ONSET- when did the symptoms start occurring (help distinguish between stable & unstable)

35
Q

What is the number one symptom of unstable angina?

A

dyspnea- 69%

36
Q

Does the physical exam help to determine unstable angina?

A

NOPE

normal in most cases

37
Q

What is the specific cardiac biomarker we use to test for ACS? whats the best lab value to get 20 minutes after symptom onset?

A

troponin 1

myoglobin (presence in bloodstream indicates tissue injury)

38
Q

Which ACS types show ST segment elevation versus depression?

A

elevation: STEMI
depression: unstable A or NSTEMI (use biomarkers to distinguish between the 2)

39
Q

What is the TIMI grading scale? what does it tell you

A

Risk score for UA/NSTEMI

more than 3 points, then tx is revascularization; less than 3, then medical management

40
Q

What are the three types of revascularization?

A

PTCA- ballooning out the artery wall to open the vessel

2) . PTCA + stent placement
3) . rotational burr/atherectomy- grinds away the plaque

41
Q

What type of revascularization should high risk NSTEMI patients have? What are these patients TIMI risk score?

A

PCI and stenting

greater than 3

42
Q

What is long term medical management after ACS?

A

BANANAS

**make sure statin is intensive/high potency

Clin Med- P (124 decks)

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