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Flashcards in Ischemic Heart Disease Deck (17)
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risk factors for development of coronary atherosclerosis


abnormal lipids

cigarette smoking



family history

male gender

lifestyle factors, such as lack of physical activity and unhealthy diet

increasing age


unstable atherosclerotic plaques

presence of inflammatory cells

thin fibrous cap

few smooth muscle cells

eroded endothelium

activated macrophages


stable atherosclerotic plaques

lack of inflammatory cells

thick fibrous cap

more smooth muscle cells

intact endothelium

foam cells


Levene's sign

putting hand over chest and squeezing


clinical types of angina

chronic, stable


anginal equivalents and silent ischemia


atypical angina

angina pectoris that is atypical in location and not strictly related to provokings factors especially in women and diabetic patients

anginal equivalents are symptoms of myocardial ischemia other than angina

dyspnea, nausea, fatigue, and faintness

more common in women, elderly, and diabetic patients


class I angina

ordinary activity does not cause angina - only with strenuous, rapid, or prolonged exertion


class II angina

slight limitation of ordinary activity - such as walking, climbing stairs rapidly, walking uphill, or exertion after meals

cold weather, emotional stress, or during first few hours after awakening


class III angina

marked limitations of ordinary physical activity - angina on walking 1 or 2 blocks on the level or 1 flight of stairs at a normal pace under normal conditions


class IV angina

inability to carry on any physical activity without discomfort or angina at rest


initial treatment of chronic stable angina

A = aspirin and antianginal therapy

B = beta-blocker and blood pressure

C = cigarette smoking and cholesterol

D = diet and diabetes

E = education


goals of therapy for chronic stable ischemia

reudce risk of mortality and CV events - prolong life

reduce symptoms - improve quality of life



reduces myocardial ischemia by closing hte late inward NA+ gate, and thus reducing compensatory Na+/Ca++ exchange

anti-ischemic effects occur in the absence of changes in heart rate or blood pressure


indications for coronary angiography

appearance of angina at rest

concern for underestimating the severity of disease

intolerance of medications

repeate stress test becoming positive in the first stage


indications for myocardial revascularization

failure of medical therapy

intolerable side effects from medical therapy

compelling anatomy

AP-associated severe cardiac dysfunction


percutaneous transluminal coronary angioplasty (PTCA)

an improvement in coronary blood flow provided by dilation and frequently implantation of a small metal stent in the dilated arterial segment to maintain vessel patency


classical angina vs atypical chest pain

classical - chest discomfort/pressure which may radiate to shoulder, left arm, jaw, back

atypical - may occur at rest, with minimal exertion