Cardiovascular and Pulmonary Systems clinical application- Angina pectoris

Question 1

what does angina pectoris result from?

Answer 1

diminished myocardial perfusion, most commonly caused by narrowing of one or more of the coronary arteries due to embolism, atherosclerosis, inflammation

Question 2

angina pectoris results from diminished __ __, most commonly caused by __ of one or more of the __ arteries due to __, __ or __

Answer 2

myocardial perfusion; narrowing; coronary; embolism, atherosclerosis or inflammation

Question 3

how is chest pain characteristic of angina pectoris produced?

Answer 3

chest pain is produced by myocardial ischemia resultant of the tissue’s oxygen demand being greater than that provided by the coronary arteries

Question 4

angina pectoris is a symptom of __ __

Answer 4

myocardial ischemia

Question 5

damage to myocardial tissue is dependent on the __, __ and __ of the ischemia

Answer 5

location, extent and duration

Question 6

certain etiologies associated with myocardial ischemia with resultant symptoms of angina pectoris may also result in localized __ damage and __ or __

Answer 6

vessel; narrowing or blockages

Question 7

risk factors for angina pectoris are consistent with those of __ __ __

Answer 7

coronary artery disease (CAD)

Question 8

risk factors (8) for angina pectoris?

Answer 8

family h/o heart disease
smoking
physical inactivity
stress
HTN
elevated cholesterol
diabetes mellitus
obesity

Question 9

how is angina pectoris typically described?

Answer 9

uncomfortable or painful feeling of tightness, pressure, fullness or squeezing in the center of the chest

Question 10

where within the body will symptoms of angina pectoris typically present?

Answer 10

on the left side of the body in the back, arm, shoulder, neck or jaw when accompanies by radiating pain

Question 11

what other symptoms are typically reported with angina pectoris?

Answer 11

SOB
unexplained fatigue

Question 12

how is angina pectoris classified?

Answer 12

stable
unstable

Question 13

stable angina

Answer 13

occurs predictably in response to activities that increase oxygen demand of myocardial tissue (exercise, stress, cold weather, large meals)

Question 14

what specific activities (4) increase oxygen demand on myocardial tissue associated with stable angina?

Answer 14

exercise
stress
cold weather
large meals

Question 15

stable angina symptoms do not typically last longer than __ minutes and are relieved with __ or __

Answer 15

15; rest or nitroglycerin

Question 16

unstable angina

Answer 16

occurs without cause and is often unresponsive to nitroglycerin

Question 17

unstable angina is often __ to nitroglyerin, where as stable angina is typically __

Answer 17

unresponsive, responsive

Question 18

why is unstable angina considered more serious?

Answer 18

it occurs without cause

Question 19

a diagnosis of angina pectoris is most often confirmed by first diagnosing the __ __ causing ischemia

Answer 19

underlying pathology

Question 20

what imaging study is most commonly used to diagnose angina pectoris?

Answer 20

12 lead ECG

Question 21

what results would indicate angina pectoris on a 12 lead ECG?

Answer 21

inverted T wave indicating myocardial ischemia

Question 22

in patients with suspected angina pectoris and normal 12 lead ECG readings, what further testing is indicated?

Answer 22

a more provocative exercise ECG or stress test

Question 23

what additional information (3) should be obtained to confirm the diagnosis of angina pectoris?

Answer 23

-medical history to identify cardiac risk factors
-patient history of symptoms including exacerbating and alleviating factors
-clinical exam to r/o other dx

Question 24

why does medical management of angina pectoris vary greatly?

Answer 24

varying symptom severity
type (stable v unstable)
underlying cause/pathology

Question 25

what might pharmacological intervention for angina pectoris target (4)?

Answer 25

vessel relaxation HR blood's clotting capability cholesterol levels

Question 26

what specific pharmacological agents (6) may be used in the treatment of angina pectoris?

Answer 26

aspirin nitrates beta-blockers statins CCBs ACE inhibitors

Question 27

if surgical intervention were indicated for a patient with angina pectoris, what is the typical goal of surgery?

Answer 27

to widen a coronary artery and improve bloodflow

Question 28

what are common surgical interventions (4) for angina pectoris?

Answer 28

angioplasty stent placement endarterectomy coronary artery bypass graft

Question 29

what are common lifestyle changes (4)prescribed to patients with angina pectoris?

Answer 29

smoking cessation weight management increased activity level stress management

Question 30

for patients with stable angina, what does physical therapy intervention typically follow?

Answer 30

a multi-phase cardiac rehab program

Question 31

what should HEP for a patient with stable angina following a multi-phase cardiac rehab program follow/include?

Answer 31

-guidelines indicated for each phase of the cardiac rehab program -continuation of safe exercise -reduction of modifiable risk factors -symptom recognition -nutritional management

Question 32

__ rehabilitation is recommended for patients with angina pectoris

Answer 32

cardiac

Question 33

patients with stable angina that are managed with __ and __ __ may initiate cardiac rehab in an __ __ therapy setting

Answer 33

medication and lifestyle changes; OP

Question 34

what is the goal of cardiac rehabilitation for patients with stable angina?

Answer 34

successful completion of rehab, allowing the patient to resume ADLs and recreational activity

Question 35

what are the long-term effects of angina pectoris?

Answer 35

-patients with angina pectoris typically have some degree of pre-existing cardiac pathology -at increased risk for developing cardiac arryhthmias/MI/cardiac arrest

Question 36

patients with angina pectoris are at increased risk for developing cardiac __, __ __ or __ __

Answer 36

arryhthmias, myocardial infarction, cardiac arrest

Question 37

patients with angina pectoris are at increased risk for developing cardiac arryhthmia, MI or cardiac arrest, with the severity of risk linked to the severity of the underlying __ process, prior __ history and patient response to __ __

Answer 37

disease; cardiac; pharmaceutical mangagement