PA Study Sesh
CAD, Stable Angina, Unstable Angina, MI!
Coronary Artery Disease
* Atherosclerosis #1 cause
* Fatty streak formation: lipid deposition in white blood cells=1ststep
* Risk Factors:
* Diabetes
* Smoking
* Hyperlipidemia
* HTN
* Male
* Age (>45 men >55 women)
* Family Hx
Stable Angina
Check out the Stable Angina Picmonic!
* Chest pain
* Substernal
* Poorly localized
* Exertional
* Radiation to arm, teeth, lower jaw
* Typically 1-5 minutes, but less than 30 by definition
* Relieved with rest or nitroglycerin
* Levine’s sign
* Clenched fist over chest
* Dx:
* EKG: ST depression, but normal in 50%
* Stress Testing:
* EKG
* + ST depressions
* Echo
* Used in pts with baseline EKG abnormalities
* Helps localize ischemia
* Pharmacologic therapy used with exercise contraindicated
* Pharmacologic=dobutamine
* Increase force of heart contractions
* Increases O2 demand
* Myocardial Perfusion Imaging
* Localizes Ischemia
* Pharmacologic=adenosine or dipyridamole
* Vasodilate normal arteries
* CI: asthmatics
* Coronary Angiogram
* GOLD STANDARD
* Gold standards are usually the test that gives us a definitive picture.
* Defines anatomy=definitive diagnosis
* Tx:
* Statin Therapy
* Helps stabilize lipid plaques
* MI is typically caused from plaque rupture vs occlusion
* Nitrates
* Venodilator (increases supply)
* Caution with use of PDE-5 inhibitors (sildenafil)
* Used for acute pain
* Advised to go to ER if used 3 doses (Q 5min)
* B blockers
* Used for daily, chronic management
* Reduces demand (negative chronotrope/inotrope)
* CCB
* Non-dihydropyridines (verapamil/diltiazem)
* Decrease vasospasm (increase supply)
* Decreases heart rate & contractility (decreases demand)
* For those who B blockers are contraindicated
* ASA
* Doesn’t address supply/demand
* Helps with platelet aggregation to prevent ACS
Unstable Angina
* Chest pain>30 minutes
* Negative cardiac enzymes
NSTEMI
* Chest pain >30 minutes
* Positive cardiac enzymes
* 3 sets Q8hours
* Creatinine Kinase (muscle breakdown marker)
* Troponin (most sensitive & specific)
* Negative
* Unstable Angina
* Treatment for Unstable Angina & NSTEMI is the same
* MONA
* Bblockers
* Heparin
STEMI
* ST elevations greater than 1 mm
* 2 contiguous leads
* May have reciprocal changes in opposite leads
* New LBB is STEMI equivalent (Carrot in V1)
* Anterior=V1-V4
* Left Anterior Descending
* Lateral= I, aVL, V5,V6
* Circumflex
* Anterolateral=I, aVL, V4-V6
* Inferior= II, III, aVF
* Right coronary artery
* Posterior Wall=V1-V2
* ST DEPRESSIONS