Cardiology - stable vs unstable angina
Terms in this set (34)
What is stable angina?
leads to ischemia
compromised coronary flow
worsened with increased demand
relieved with rest
ACE-I / ARBs
Ca channel blockers
What are Acute Coronary Syndromes?
refers to any constellation of syndromes caused by myocardial ischemia
includes: unstable angina, non STEMI and STEMI
What does an elevated ST segment reveal?
acute myocardial infarction
What does no ST elevation on EKG with a symptom of ischemic discomfort indicate?
not a complete occlusion
can be unstable angina or myocardial infarction
if (+) troponin/CPK-MB = myocardial infarction
What does an ST elevation on EKG with ischemic discomfort indicate?
this is a CARDIAC EMERGENCY!!
time = muscle!
What is rest angina?
angina that occurs at rest, usually >20 mins
What is new-onset angina?
angina which markedly affects ordinary daily activity
What is progressive angina?
previously diagnosed angina that has become distinctly more frequent, longer in duration, or lower in threshold
high risk patient risk factors with unstable angina or nonSTEMI
hx of rest angina
>64 years old
need for IV nitro
What is angina associated with pulmonary edema?
PE findings for high risk patients with unstable angina or nonSTEMI
pulmonary edema, S3 gallop
transient mitral regurg
EKG findings for high risk patients with unstable angina or nonSTEMI
ST depression or transient elevation
T wave inversion with chest pain
What are four cardiac biomarkers?
BNP (brain natriuretic peptide)
What does BNP suggest?
that the heart is straining
>1000 = HF, COPD
its secreted from the ventricle under stress
TIMI Risk Score for unstable angina
evaluates risk of death or ischemic events
What does an elevated TIMI risk score for unstable angina mean?
We should treat invasively!
low TIMI risk scores do better with conservative treatments
TIMI Risk Factors for unstable angina
>65 years old
hx of coronary artery stenosis >50%
3+ cardiac risk factors
use of ASA in past 24 hours
2+ angina events in past 24 hours
ST segment deviation (transient elev. or depression)
increased cardiac biomarkers
How do ASA and Plavix(clopidogrel) work?
inhibit platelet aggregation by blocking activation of GP IIbIIIa receptors
Treatment for moderate risk patients
GP IIbIIIa inhibitor (ASA, plavix)
can be combined with LMW heparin
high dose statin therapy for plaque stabilization
Treatment for High risk patients
Predictors of mortality when patient has STEMI
clinically evident HF
Patients are at an increased risk of STEMI if they also have hx of...
anterior wall MI
right ventricular MI
advanced AV block
TIMI risk for STEMI is useful for..
elevated TIMI risk indicates
high mortality rate within 30 days post MI
contraindications for Thrombolytics
prior intracranial hemorrhage
known CV lesion
head trauma within 3 months
prior lytics within in 6 months
What is a trans-mural STEMI?
causes the whole wall to become necrotic
Why do we give a stress test?
For functional evaluation using an EKG
it determines if the ischemia is clinically significant
tx is either medical therapy or catheterization and revascularization
What is an interpretable EKG?
no bundle branch block
no abnormal ST segments
What is an uninterpretable EKG?
abnormal ST segments
bundle branch block
the patient has an interpretable EKG and they can exercise, we perform the stress test with..
the patient on the treadmill
if the patient has an interpretable EKG but they cannot exercise, how do we perform the stress test?
pharmacological stress with a nuclear scan
If the patient has an EKG that is uninterpretable and they can exercise, how do we perform the stress test?
on the treadmill with a stress echo
on the treadmill with a nuclear scan
How does troponin act in the body?
It takes >12 hours to become elevated after the onset of MI
it becomes elevated faster with reperfusion