Ischemic Heart Disease, Angina, Unstable Angina Flashcards Preview

ClinMed Exam 4 CARDS 1 > Ischemic Heart Disease, Angina, Unstable Angina > Flashcards

Flashcards in Ischemic Heart Disease, Angina, Unstable Angina Deck (25)
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1

Characterized by insufficient oxygen supply to cardiac muscle, resulting in angina pectoris

Ischemic heart disease

*usually occurs when there is an imbalance between myocardial oxygen supply and demand*

2

What most commonly causes ischemic heart disease?

Atherosclerotic narrowing of coronary arteries.

Less often, but sometimes, cause by constriction of coronary arteries (vasospasm - cocaine use)

3

Rare causes of ischemic heart disease

Congenital abnormalities
Emboli
Arteritis
Dissection

4

Diagnostic criteria of Metabolic Disease

3 or more of the following:

1. Abdominal obesity
2. triglycerides > 150mg/dL
3. HDL < 40mg/dL men <50mg/dL women
4. Fasting glucose >110mg/dL
5. HTN

5

Patients with cerebrovascular disease, peripheral arterial disease, abdominal aortic aneurysm, chronic or end stage renal, or diabetes are considered HIGH risk for what?

Ischemic heart disease

6

Characterized by paroxysmal chest "squeezing" or pressure, often with sensation of smothering and fear of impending death

Angina

7

Prinzmetal (variant) angina?

Caused by vasospasm at rest, with preservation of exercise capacity

8

When should a diagnosis other than stable angina be suspected?

If pain is not completely resolved after 3 doses of the patient's usual sublingual NTG

Consider UA, MI, or other

9

How often can sublingual NTG be repeated for angina chest pain?

Every 5 minutes, up to 3 times

10

3 common patterns of presentation for UA

1. Angina at rest
2. New onset of angina symptoms
3. Increasing pattern of pain in previously stable patients

11

What does the American Heart Association say is the most common presentation of UA?

Angina at rest

12

When might UA be suspected?

Pain is less responsive to NTG

Pain lasts longer

Pain occurs at rest or with else exertion than previous episodes of angina

13

"Clenched fist over the sternum, clenched teeth"

Levine sign

14

Where might pain from angina pectoris radiate?

1. Pain is usually midsternal

2. Classically radiates to the left (jaw, shoulders, arms, wrist, back of neck, combo)

15

Where do women tend to report radiating pain in angina pectoris? (more frequently than men)

Right shoulder and back pain

16

How long does stable angina usually last?

Less than 3 minutes

17

Angina lasting more than 30 minutes?

Suggests UA, MI, or other

18

Most useful and cost-effective, noninvasive test for Ischemic Heart Disease (Angina)

Exercise stress testing
(Or Chemical stress test if patient can't move well)

EKG before, during, and after stress

19

What is considered a positive exercise stress test for ischemic heart disease?

ST-segment depression of 1 mm (0.1mV)

The ischemic ST-segment response generally is defined as flat or downsloping depression of the ST segment >0.1 mV below baseline (i.e., the PR segment) and lasting longer than 0.08 s (Fig. 293-1).

20

Definitive diagnostic procedure - which is rarely used - for ischemic heart disease?

Coronary angiography

21

Causes more deaths and disability and incurs greater economic costs than any other illness in the developed world

Ischemic Heart Disease

22

Most common, serious, chronic, life-threatening illness in US

Ischemic Heart Disease

13 million ppl have IHD, >6 million with angina, >7 million with MI

23

Does Angina pain radiate to trapezius muscles?

No. That is more typical of PERICARDITIS

24

"Equivalent" symptoms of myocardial ischemia other than angina, which present with elderly and diabetic patients

Dyspnea, nausea, fatigue, faintness

25

Treatment of IHD

Lifestyle

Identify / treat aggravating factors (HTN)

Sublingual NTG tablets

Anticoagulants

Beta blockers or
ACE inhibitors if CHF included

Revascularization via angioplasty / bypass