Pathophys and Clinical Presentation of Angina Pectoris Flashcards Preview

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Flashcards in Pathophys and Clinical Presentation of Angina Pectoris Deck (29):
1

Angina Pectoris

Painful myocardial ischemia

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3 Kinds of Angina Pectoris

Unstable Angina - unstable plaque, oxygen supply
Stable Angina - stable plaque, oxygen demand
Variant Angina - coronary artery focal spasm

3

3 Determinants of Myocardial O2 Demand

HR
Contractility
Wall Stress

4

Wall Stress

(Pressure x Radius)/2(thickness). Only components that vary acutely are pressure and radius, which you can estimate w/ AL (BP) and PL (jugular veins)

5

O2 Extraction and Flow

Constantly extracting max O2, flow is the thing that fluctuates. Flow parallels demand in system with adequate flow reserve

6

Ischemic Threshold

Rate Pressure Product: Systolic BP x HR at presentation of angina. Reflects flow reserve, anything above that get ischemia and supply can't keep up w/ demand

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RPP Values

>20k is high O2 demand so demand/stable ischemia. Lower RPP means no cardiac reserve so situation more critical. Don't use nitroglycerin bc that drops P more

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2 Components of Coronary Flow Reserve

Epicardial stenosis and microvascular dilation and shit

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CAD & Degree of Ischemia =

Endothelial Injury + Microvascular Disease + Epicardial Stenosis

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3 Criteria for Typical Angina

Retrosternal chest pain
Provoked by exertion/emotion
Relieved by rest/nitroglycerin

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Atypical Angina

Meets 2 criteria for typical angina

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Atypical Angina CAD Prevalence

50%. So how to tell? 2 Cardiac enzyme tests 6-8 hrs apart

13

Canadian Classification of Angina

I - extraordinary exertion
II - moderate exertion
III - Mild Exertion
IV - rest

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NY vs. Canadian Classification

NY for HF, Canadian for Angina

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3 Types of ST Segment Depressions (& which dangerous)

Upsloping - maybe
Horizontal or downsloping - better chance of CAD and more serious

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Variant Angina

Coronary artery spasm from focal vasoconstriction. Paradoxical and unprovoked w/ little or no plaque. Can provoke w/ some med to test

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Acute and Chronic Variant Angina Treatments

Acute: Nglycerin
Chronic: Ca channel block
Smooth muscle dilation

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3 Cocaine Induced Ischemia Mechs (& which one don't give BBs for)

Increased O2 demand w/ limited supply
Vasoconstriction - don't give BBs because alpha Rs left so can get more spasm
Accelerated Atherosclerosis/Thrombosis/Plaque Rupture

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4 Situations Where Don't Give BBs

Acute systolic HF
Active Wheezing
High Grade Arrhythmias Causing Bradycardia
Cocaine Induced Vasoconstriction?

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3 Categories of Acute Coronary Syndrome (& how to distinguish)

Unstable Angina (also has ST depression)
Non-STEMI - (tell from unstable angina via troponin, cardiac enzymes)
STEMI - obvious

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ST Dep vs. Elevation and Anatomical Location

Depression not anatomically specific, elevation is

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4 Clinical Syndromes of Unstable Angina

Rest Angina - acute coronary insufficiency
New Onset Angina - w/ crescendo pattern, happens first time and person stops activity, pain keeps getting worse so not like stable that relieves on rest
Crescendo Angina
Postinfarction Angina

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Stable vs. Unstable Angina Treatment (2/4)

Treat both w/ aspirin/nitrates/BBs/Ca blockers, but w/ unstable also need to treat aggressively w/ anti-platelet/heparin

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Ischemic Cascade (& important points)

Decreased Relation (diastolic dysfunction, S4), systolic dysfunction (S3), filling, ST alterations (so need serial ones bc might not have presented), angina, so angina at end of ischemic cascade

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Stress Test if Pt Can't Walk

Chemical stress test idiot

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When to Treat w/ ACEis

EF<40 (& HTN and shit of course)

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Timeframe Necessary b/w PDEis and Nitrates

48 hrs. So stop popping all the Viagra Ronak

28

BBs Management of Angina

Reduce O2 demand by reducing HR/contractility/wall tension

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Ca Channel Blocker Management of Angina

Not used acutely, only cronic