by mtoom


keywords:
Bookmark and Share



Front Back
  • What is stable angina?
  • How occluded is artery?
  • Where is ischemia occurring?
  • Describe ECG changes
  • Does it resolve with rest or nitro?
  • Angina such that symptoms (e.g. chest pain) disappear when exertion stops (within a few minutes)
  • Artery >70% occluded
  • Transient subendothelial ischemia
  • ECG: Transient ST-depression
  • Resolves with rest/nitro
  • What is unstable angina?
  • How occluded is artery?
  • Where is the ischemia?
  • Transient ECG changes?
  • Does it respond to nitro/rest?
  • Similar to stable angina except more severe stenosis
  • Artery >90% occluded
  • Ischemia is subendocardial
  • ECG: Transient ST-depression and may be T-wave inversion
  • Does not respond to nitro/rest
  • What are the 4 symptoms of atypical angina?
  • Atypical angina is seen in patients with what chronic condition? 
  • Weakness
  • Fainting
  • Sweating
  • Nausea

Seen in patients with Diabetes
What is myocardial infarction?
Death of myocardial tissue secondary to ischemia.
How long after ischemia does myocardial infarction occur?
15-20 minutes
In NSTEMI, describe:
  • Tissue changes (be specific)
  • ECG changes
  • Tests 
NSTEMI: Partial occlusion and necrosis
  • Subendocardial tissue ischemia and necrosis
  • ST depression, T-wave inversion/depression
  • Test for Tropinin, CK-MB 
In STEMI, describe:
  • Tissue changes
  • ECG changes
  • Tests 
  • Transmural tissue necrosis
  • ST elevation
  • Troponins or CK-MB
Describe symptoms of angina (2)
  • Retrosternal chest pain, burning or heaviness
  • Radiates to neck, jaw, epigastrium, shoulders, left arm
Describe distinguishing features of:
  • Stable angina
  • Unstable angina
  • Acute MI
  • Pericarditis
  • Stable angina:
    -Exercise
    -Stress 
  • Unstable angina:
    -Crescendo pattern
    -Low tolerance for exertion 
  • Acute MI
    -Sudden onset
    -Lasts 30 minutes
    -SOB
    -Weakness
    -Nausea
    -Vomiting 
  • Pericarditis
    -Pericardial friction rub 
Describe aortic dissection presentation
  • Excruciating ripping pain (sudden onset) in anterior of chest, often radiating to back
  • Marked severity of unrelenting pain
  • Occurs in setting of HTN
Describe pulmonary embolus presentation
  • Sudden onset dyspnea and pain
  • Pleuritic pain with pulmonary infarction
  • Dyspnea, tachypnea, tachycardia, signs of right heart failure
Describe 3 pulmonary causes of chest pain
  • Pleuritis and/or pneumonia
    -pleuritic pain, usually brief over involved area 
  • Tracheobronchitis
    -burning discomfort in midline 
  • Spontaneous pneumothorax
    -sudden onset unilateral pleuritic pain with dyspnea
Describe 4 gastrointestinal causes of chest pain
  • Esophageal reflux
    -substernal epigastric discomfort 
  • Peptic ulcer
    -prolonged epigastric or substernal burning 
  • Gallbladder disease
    -Epigastric or right upper-quadrant pain 
  • Pancreatitis
    -Prolonged, intense epigastric and substernal pain 
Describe 3 musculoskeletal causes of chest pain
  • Costochondritis
    -sudden onset of intense fleeting pain, reproducible with pressure over affected joint 
  • Cervical disc disease
    -sudden onset fleeting pain, reproducible with movement of neck 
  • Trauma/strain
    -reproduced by palpation or movement of chest walls or arms 
Describe 1 infectious cause of chest pain
  • Herpes zoster
    -prolonged burning pain in dermatomal distribution
Describe 1 psychological cause of chest pain
  • Panic disorder
    -chest tightness or aching, often accompanied by dyspnea
    -evidence of other emotional disorder 
Describe conservative treatment for Stable Angina
  • Exercise
  • Smoking cessation
  • Diet
  • Stress reduction
Describe medical/pharma treatment for Stable Angina

Acute angina
  • Sublingual nitro

Prevention of recurrent episodes
  • Nitrates
  • β-blockers
  • Ca2+ channel blockers

Prevention of MI
  • Aspirin
  • Lipid-regulating (statins)
  • ACE inhibitors
x of y cards