Angina Latest Update with Verified Solutions

Angina Latest Update with Verified Solutions Angina Coronary arteries are unable to supply oxygenated blood to the heart resulting in myocardial ischemia Precipitating Factors of Angina Physical exertion, temperature extremes, strong emotions, consumption of heavy meals, tobacco use, sexual activity, stimulants (cocaine, amphetamines), cicadian rhythm patterns. Most all these increase HR, O2 demand, and increases workload of the heart. PQRST Assessment of Angina P-precipitating events: what events trigger pain (rest, exercise) Q-quality of pain: what does the pain feel like? R-radiation of pain: where is the pain located? S-Severity of pain: On a scale of 0-10 T-timing: when di the pain begin? Characteristics of Angina Described as a constrictive, squeezing, heavy, choking, suffocating sensation, indigestion or burning sensation in epigastric region. May radiate to neck, jaw, and shoulders. Pain usually lasts for only a few minutes and pain at rest is unusual. ECG reveals transient ST segment depression indicating ischemia. Chronin Stable Angina (exertional) Refers to chest pain that occurs intermittently over a long period of time with the same pattern on onset, duration, and intensity of symptoms. Resolves when factors that cause episode are relieved. Responds to medication. Triggered by increase in activity, emotional excitment, large meals, cold exposure. Tx for Chronic Stable Angina Reduce intensity & frequency of aniginal attacts, increase O2 supply, decrease O2 demand. Prinzmetal's Angina (variant) Often occurs at rest, usually in response to spasm of a major coronary artery which restricts blood flow to heart resulting in insufficient oxygenation to the heart, can be triggered by smoking. Rare and usually seen in pt's with migraines and Raynaud's phenomenon. Tx for Prinzmetal Usually treated with CCB (dilates arterial smooth muscle reducing BP and decreasing cardiac workload) and/or nitrates (dilates veins, reducing amount of blood returning to heart and dilates coronary arteries to bring more blood to myocardium), and beta-blockers (decreases the HR, myocardial contractility, and reduces CO and workload) Unstable Angina Rupture of thickened plaque, exposing thrombogenic surface, symptoms occur more frequently and last longer. Pain may occur at rest and is usually more intense. Can have severe CAD with complications of vasospasm, platelet aggregation, thrombi, and emboli. Higher risk of death with this form. Nitroglycerin Therapy Nitrates have a vasodilator effect on peripheral blood vessels and coronary arteries and collateral vessels reducing O2 demand to myocardium. Higher doses aid in relaxing systemic arterioles resulting in lowering