Exam 1 SIHD Lecture Set

Question 1

stable angina pectoris (fixed stenosis)

Answer 1

-“macrovascular disease”
-demand (upon exertion) ischemia

Question 2

variant or Printzmetal’s angina

Answer 2

-“vasospastic disease”
-supply ischemia
-artery closes due to spasm causing alteration in blood supply to that muscle

Question 3

unstable angina pectoris (thrombus)

Answer 3

-supply ischemia

Question 4

O2 demand

Answer 4

-Wall tension (systolic pressure and left ventricular volume)
-Contractility
-HR

Question 5

O2 supply

Answer 5

-O2 carrying capacity
-Vascular resistance —> Coronary blood flow

Question 6

unstable angina characteristics

Answer 6

-medical emergency that can lead to MI

Question 7

stable angina characteristics

Answer 7

-chest pain that can be relieved by SL NTG or rest

Question 8

variant or Printzmetal’s angina characteristics

Answer 8

-chest pain caused by reduced blood flow to muscle via spasms that restrict bloodflow

Question 9

what leads to ischemia

Answer 9

fixed stenosis, vasospasm, thrombus —> decreased coronary blood flow
or
increased HR, contractility, afterload, preload —> increased oxygen consumption

Question 10

ischemia leads to what

Answer 10

angina, anginal equivalents (SOB, change in tissue color)

Question 11

Explain the pathophysiology of stable angina

Answer 11

-stable angina pectoris is usually associated with large single to multi-vessel ASCAD
-ischemia leads to CP caused by a fixed obstruction in epicardial artery
~85% of pts with angina pectoris have significant CAD (defined as >70% atherosclerotic reduction) in a major epicardial coronary vessel
–reductions of 50-70% usually do not cause ischemia

Question 12

what is myocardial ischemia?

Answer 12

imbalance between myocardial oxygen supply and demand (usually secondary to increased work, or after a pt exerts themselves)

Question 13

where does angina come from in stable angina?

Answer 13

symptoms result from ischemia (does not include myocardial necrosis in stable angina)

Question 14

clinical presentation of stable angina

Answer 14

PPQRST
-precipitating factors (exertion)
-palliative measures (rest and/or SL NTG)
-quality and quantity of the pain (heavy, tight, squeezing)
-region and radiation (substernal)
-severity of pain (>5/10)
-timing and temporal patterns (>20 min, relieved in 5-10 min)

Question 15

guidelines for management of stable angina

Answer 15

ABCDE
-aspirin and anti-anginals
-beta blocker and blood pressure
-cholesterol and cigarettes
-diet and diabetes
-education and exercise