Angina Pectoris

Question 1

This is a strangling/uncomfortable sensation in the chest and neighboring anatomic structures caused by myocardial ischemia.

Answer 1

Vagina pectoris

Question 2

This type of vagina is predictable, transient, and elicited by exertion or emotional stress.

Answer 2

Chronic stable vagina

Question 3

What forms in the coronary arteries to cause chronic stable angina?

Answer 3

Atheromatous plaque

Question 4

In chronic stable angina, there is endothelial dysfxn, which results in the inability of the vessels to do what?

Answer 4

Dilate

Question 5

This subtype of chronic stable angina is when there is a constant amount of physical activity that’s required to induce angina.

Answer 5

Fixed threshold

Question 6

What are the alterations to cause the variable chronic stable angina?

Answer 6

vascular tone over the sites of fixed stenosis

Question 7

This type of vagina results when some1 with stable angina starts to have sudden increases in tempo and duration of ischemic episodes that occur with lesser degrees of exertion

Answer 7

Unstable vagina

lol ok ill stop.

Question 8

Unstable vagina (I DIDNT STOP HAHAHA) is usually a precursor to what gnarly condition?

Answer 8

MI

Question 9

Unstable angina and MI are classified as what “syndromes”?

Answer 9

Acute coronary syndromes

Question 10

What happens to the atherosclerotic plaque to cause platelet aggregation and thrombosis in acute coronary syndromes?

Answer 10

rupture

Question 11

This type of angina is when a pt gets episodes of focal coronary artery spasm in the absence of overt atherosclerotic lesions.

Answer 11

Variant (prinzmetal) angina

SO F-ING METAL

Question 12

Which nervous pathway may be increased in activity in combo with endothelial dysfxn to cause variant angina?

Answer 12

SANS

Question 13

True or False: variant angina occurs typically at rest.

Answer 13

True!

Question 14

True or False: typically, angina presents with 5-10 minutes of intense pain in the chest.

Answer 14

False. It’s usually a feeling of pressure, discomfort, tightness, burning, or heaviness

Question 15

This sign is indicative of angina, where the pt puts their fist over their chest when describing the discomfort.

Answer 15

Levine sign

Question 16

What are the accompanying Sx of angina?

Answer 16

tachycardia, disaphoresis, nausea, dyspnea, transient fatigue, and weakness.

Question 17

This is the condition where there are episodes of cardiac ischemia, but the pt doesnt experience any perceptible pain or discomfort.

Answer 17

Silent ischemia

Question 18

What % of pts with stable angina can have silent ischemia?

Answer 18

40%

Question 19

This is the syndrome when pts have the Sx of typical angina pectoris, but there is NO EVIDENCE of significant atherosclerotic coronary stenosis on angiograms.

Answer 19

Syndrome X

queue the X files music

Question 20

What is the most likely problem with the small coronary vessels to cause Syndrome X?

Answer 20

inadequate vasodilation

Question 21

What is the most important part of the examination to find out which type of angina the pt has?

Answer 21

History

Question 22

What 3 things must u ask about for the type of discomfort they feel?

Answer 22

percipitants, remission, frequency

Question 23

What will you see on physical examination during an angina attack?

Answer 23

tachycardia, HTN, mitral regurg, palpatory ventricular contraction abnormalities, S4 gallop

Question 24

Which test must u do during an angina attack?

Answer 24

EKG

Question 25

What will happen to the ST segment during subendocardial ischemia?

Answer 25

depressions (with horizontal or downsloping)

Question 26

What will happen to the ST segment during transmural ischemia?

Answer 26

ST elevation

Question 27

What is the criteria for a + stress test for cardiac ischemia?

Answer 27

EKG showing ST depression

Question 28

This is the test u can do at the peak of exercise, where u inject radionucleotides to see cold spots (areas of ischemia)

Answer 28

Myocardial perfusion imaging

Question 29

After what 2 tests do u decide to do a PET scan?

Answer 29

1. EKG. must have baseline abnormality | 2. stress test. must be discordant.

Question 30

Which heart chamber can be assessed during by echocardiography during an exercise echo?

Answer 30

LV

Question 31

What happens to the LV to give a + exercise echo tests?

Answer 31

if regions of LV contractile dysfxn develop with exertion

Question 32

So say your pt can't exercise (like they broke their legs). What 2 drugs can u give to induce cardiac stress to test for angina?

Answer 32

inotropines (like dobutamine) or vasodilators

Question 33

This test is the most direct way to look at the coronary arteries and is the gold standard to angina Dx.

Answer 33

Coronary angiography

Question 34

What is a big limitation to coronary angiography (think anatomy)?

Answer 34

it only shows u physical problems, and can't give u info about pathophysiilogical consequences, composition of plaques, or vulnerability to rupture.

Question 35

CT is very good at viewing what type of change in coronary arteries?

Answer 35

calcification (but not much else)

Question 36

Which drug can the pt take to cease the activity of acute angina?

Answer 36

Nitroglycerin

Question 37

How can B-blockers help treat recurrent ischemic episodes of angina?

Answer 37

reduce myocardial O2 demand by decreasing chrono- and ionotropic events

Question 38

What is the class of drugs to prevent acute cardiac events?

Answer 38

anti-platelet therapies

Question 39

This is the procedure where they insert a balloon into the artery and inflate it to dilate the stenotic portion of the coronary artery.

Answer 39

PTCA (percutaneous transluminal coronary angioplasty)

Question 40

What can be placed during a PCTA to prevent re-stenosis?

Answer 40

Stent

Question 41

What can they coat the outside of the stent with to give a little antiproliferative properties to the opened artery?

Answer 41

drugs (sirolium, everoliums, paclitaxel)

Question 42

What is the most common vessel to be used in a CABG surgery?

Answer 42

Saphenous v.