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chest discomfort when heart mscle does not receive enough o2, not a disease it is a symptom
squeezing and tightening not pain. stimulation of nerve endings by lactic acid and c02 that builds ischemic tissue
primary reason for insufficient blood flow is narrowing of the coronary arteries by atherosclerosis 75% of artery must be occluded before ischemia occurs
Factors non cardiac
decreased/increased 02 supply, anemia, hypoxemia,pneumonia,anxiety, cocaine, htn
factors cardiac
coronary artery spasm, coronary artery thrombosis, dysrhythmias, HF, valve disorder
P=precipitating events Q=quality of pain(feeling) R=Radiation of pain S=Severity of pain (1-10) T=Timing when it began how has it changed
Stable Angina
Constant and predictable,brief episodes of discomfort r/t activities, squeezing not sharp
Unstable angina
aka prefarction angina intermediate severity between angina and acute MI men and women 60-80y/o
unstable angina
sx occur at rest lasting >20 min., painful, pts untreated risk for heart attack or death
Prinzmetal's angina(variant angina)
occurs at rest, response to a major coronary artery spasm. absence of cad,
Fx of prinzmetals angina
increase o2 demand increased histamine,angiotesin epinephrin)pt experience angina and ST elevation
Prinzmetals angina
occur in healthy people between 40-50 y/o with no evidence of CAD only last a few min. can cause serous dysrhythmias vtah,vfib
pts. hx related to sx of ischemia, 12 lead ekg done and lab values to make diagnosis
stress test, cardiac cath, angiogram, nuclear scan, echocardiogram. C react. protein (high levels associated with coronary calcification)
Chronic stable angina, have cardiac cath and stents inserted with ballon angioplasty
aimed at preventing MI or sudden death, short acting nitrates=dilate peripheral blood vessels, decrease 02 demand, dilates coronary arteries and collateral vessels, Increase blood flow
Long acting nitrates Isosorbide dinitrate (isordil and isosorbide mononitrate(imdur)
S/E of all nitrates H/a, Dilate veins, reduce amount of blood to the heart, dilate coronary arteries=more blood to myocardium, reduce preload/afterload, venous return increase
Beta adrenergi Blockers
perferred drugs propranolol(inderal),metoprolol(lopressor),nadolol(cogard),atenolol(tenormin, and coreg
beta adrenergic blockers
Decrease contractility, HR, SVR and BP=decrease o2 demand, reduces cardiac output and workload
Calcium channel blockers
contraindicated poor tolerated, dont control angina. used if pt. can't tolerate beta blockers or SE of nitrates or have pain despite beta blockers and nitro
Ca channel blockers
Amlodipine(norvasc) and felodipine are the ca drugs of choice who have HF. Dilate arterial smooth muscle reduce b/p and decrease workload, some decrease HR, and dilate coronary arteries
certain high risk pts. benefit from the addition of ACE (captopril) use with pts with dm, and cad
treat chronic angina based on antianginal and antiischemic effects
antiplatelet aggregation
plavix, ticlid
high risk for MI
prevents formation of new clots
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