Angina/MI (201)

Question Answer
What causes Angina? Imbalance of myocardial o2 supply vs o2 demand
Chronic stable angina Predictable, happens with exertion
Unstable angina Medications and rest no longer relieve symptoms
Nocturnal Angina Angina caused by laying down at night. From fluid restricting blood flow
Precipitating factors of angina (4) Physical exertion
Exposure to extreme temperatures
Eating heavy meals
Stress
Typical signs and symptoms of angina Heavy feeling in chest
Crushing chest tightness
Stabbing pain in chest
SOB
Fatigue
Radiating pain in neck, jaw, or arms
Atypical angina symptoms Mild indigestion
Epigastric pain
Nausea/ vomiting
Diaphoresis
Dizzy was
HTN
Anxiety

Diagnostic tests for Angina (6) not including labs 12 lead EKG
Chest X-ray
Cardiac angiogram
Echo
Stress test
CT angiogram
Labs drawn specifically for Angina (6) Troponin
CK-MB
Lipid profile
CRP
Homocysteine
A1C
Medications for Angina (5) Nitroglycerin
Beta-Adrenergic blockers
Calcium Chanel blockers
Antiplatelet medication
O2
What does nitroglycerin do? Decreases preload
Decreases after load
Dilates veins/arteries
What do beta-adrenergic blockers do? Decreases hr
Decreases BP
Decreases myocardial contractility
3 examples of beta blockers Metoprolol, atenolol, carvedolol
What do calcium channel blockers do? Decrease hr
Decrease contractility
Relax blood vessels
3 examples of calcium channel blockers Ditilazem
Verapamil
Amlopidine
Which calcium channel blockers work primarily by reducing both hr and BP? Diltiazem
Verapamil
Which calcium channel blockers work by primarily lowering BP and not affecting hr as much? Amlopidine
Nifedipine
List 4 anti-platelet medications Aspirin
Plavix
Heparin
Lovenox
PQRST assessment for chest pain Precipitating factors
Quality of pain
Risk factors
Severity of pain
Timing
Acute coronary syndrome Acute onset of myocardial ischemia that may lead to myocardial cell death if untreated
What differentiates unstable angina from stable angina Change in usual pattern
New in onset
Occurs at rest
Worsening pattern
Myocardial infarction Myocardial tissue/cell death as a result of inadequate myocardial oxygen supply
Most common cause of myocardial infarction Rupture of plaque and formation of thrombus
What does STEMI stand for? ST elevation myocardial infarction
What is a STEMI Coronary artery is completely blocked off by a clot, virtually all heart muscle being supplied by that artery starts to die.
NSTEMI
Blo d clot partially occluded artery, as a result only a portion of the heart muscle being supplied by the affected artery dies.
Where are most MI's located The left ventricle
Other causes of MI Prolonged coronary artery spasm
Acute blood loss
Anemia
Drug induced
Dysrhythmias
Medication management of MI (MONA) Morphine
Oxygen
Nitroglycerin
Aspirin
Post MI medications Beta blockers
ACE inhibitors
Fibrinolytic therapy
PCI/CABG
Cholesterol lowering drug
Aspirin
Plavix
Heparin
What test is most indicative of cardiac damage Troponin 1
Variant angina Prolonged severe, and occurs at the same time each day, usually in the morning