Term
| structural or functional heart damage due to decreased or dysfunctional coronary blood flow |
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Definition
| Coronary Heart Disease (CHD) |
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Term
| atherosclerotic narrowing of the coronary arteries that supply blood and oxygen to the heart |
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Definition
| Coronary artery disease (CAD) |
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Term
| vasospasm that narrows the coronary arteries that supply blood and oxygen to the heart |
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Definition
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Term
| predictable/reproducible chest pain that occurs with exertion or stress (including emotional); transient myocardial ischemia from atherosclerotic lesions; duration is sort (30 seconds to 5 minutes); relieved by rest, reduction in stress or NTG |
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Definition
| Stable Angina (effort angina) ~80-85% |
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Term
| unpredictable chest pain that occurs at rest (while sleeping); due to coronary artery vasospasm |
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Definition
| Prinzmetal Angina (variant angina) ~5-10% |
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Term
| frequent bouts of chest pain at rest (or minimal exertion) with increasing intensity; disruption of plaque, platelet thrombi, < 100% blockage |
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Definition
| Unstable Angina (crescendo angina) |
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Term
| coronary artery over-contraction |
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Definition
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Term
| Condition of ischemic event |
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Definition
| myocardial oxygen demand >>> supply |
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Term
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Definition
| myocardial ischemia --> angina symptom |
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Term
| causes of increased oxygen demand |
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Definition
| increased heart rate, increased contractility, increased myocardial wall tension |
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Term
| causes of decreased oxygen demand |
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Definition
| decreased coronary blood flow; low blood oxygenation |
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Term
| duration 5-15 minutes; visceral pressure; provoked with effort, relived with rest and NTG; substernal with radiation |
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Definition
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Term
| 5-15 minutes; visceral pressure, provoked spontaneously; relieved with NTG; substernal with radiation |
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Definition
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Term
| Duration minutes-hours; superficial quality; spontaneous onset and relieved with time; located in left anterior |
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Definition
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Term
| 10 min to 1 hour duration; visceral quality; spontaneous, exercise, or lying down; relieved with food, antacids, H2 blockers, PPIs; located substernal with radiation |
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Definition
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Term
| duration hours; visceral burning; occurs when lack of food, acidic foods; relieved with food, antacids, h2 blockers, PPIs; located epigastrically and substernally |
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Definition
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Term
| duration is hours; visceral quality; spontaneous with food and relieved with time and analgesics; epigastric with radiation |
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Definition
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Term
| Variable duration; superficial quality; provoked by head and neck movement; relieved with time and analgesics; located on arm and neck |
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Definition
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Term
| 2-3 min duration; visceral quality; provoked by emotion and tachypnea; relieved by removal of stimulus; substernal location |
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Definition
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Term
| variable duration; superficial quality; provoked with movement, relieved with time and analgesics; variable location |
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Definition
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Term
| duration about 30 min, visceral pressure; spontaneous provocation, relieved with rest and bronchodilators; substernal location |
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Definition
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Term
| normal in 50% of patients with angina not experiencing an acute attack |
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Definition
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Term
| Chronic Stable Angina Step #1 |
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Definition
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Term
| Chronic Stable Angina Step #2 |
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Definition
| infrequent episodes of angina (1-2 week/month) use prn nitroglycerin for symptomatic relief |
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Term
| Chronic Stable Angina Step #3 |
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Definition
| If angina occurs daily or multiple times daily, initiate beta blocker therapy (esp. in pts with increased HR) |
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Term
| Chronic Stable Angina Step #4 |
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Definition
| if patients cannot tolerate BB initiate CCB |
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Term
| Chronic Stable Angina Step #5 |
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Definition
| if serious CIs to BB or CCB therapy initiate long-acting NTG therapy |
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Term
| Chronic Stable Angina Step #6 |
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Definition
| when all else fails... surgical intervention (PCI, PTCA, CABG) |
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Term
| Risk factor modification in chronic stable angina |
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Definition
| Antiplatelet therapy (all patients); smoking cessation; manage hypertension; control dyslipidemia; treat diabetes; weight loss; annual flu vaccine |
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Term
| Use of NTG for infrequent episodes of angina |
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Definition
| converted to NO --> vasodilation of the coronary arteries |
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Term
| Beta blocker therapy (daily angina) |
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Definition
| Metoprolol (B1), Propranolol (B1, B2); CI in pts with HR < 50 bpm, CHG, heart block or acute bronchospasm |
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Term
| Preferred for angina with variable thresholds |
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Definition
| Calcium Channel Blocker therapy |
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Term
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Definition
| Dihydropyridine- amlodipine; Non-DHP- diltiazem and verapamil |
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Term
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Definition
| preferred in patients with conduction issues or EF < 35% |
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Term
| used in chronic stable and variant angina, hypertension |
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Definition
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Term
| increases oxygen supply to myocardial tissue |
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Definition
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Term
| decreases myocardial oxygen demand |
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Definition
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Term
| increases oxygen supply to myocardial tissue |
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Definition
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Term
| place in therapy not determined; may be used in combo therapy with hemodynamically acting agents (European guidelines) |
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Definition
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Term
| inhibits cardiac later stage sodium channels; doesn't decrease HR, BP, contractility or vasodilate ; only approved for chronic angina |
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Definition
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Term
| mechanically widen the stenotic lesions to improve flow |
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Definition
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Term
| angina at rest versus w/ exertion, can occur in clusters; due to coronary vasospasm NOT atherosclerotic plaques |
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Definition
| Prinzmetal (Variant) Angina |
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Term
| risk factors for prinzmetal angina |
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Definition
| younger age; smoking; cocain/stimulant use; differs from atherosclerotic disease |
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Term
| DO NOT USE BETA BLOCKERS (prolong myocardial ischemia); CCB preferred over nitrates; add NTG prn or isosorbie dinitrate to CCBs |
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Definition
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Term
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Definition
| once therapy works, it can be stopped. slowly withdraw therapy, reinitiate if chest pain returns |
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