Medical students and doctors can use these printable flash cards on stable angina.
There are 29 flash cards in this set (5 pages to print.)
To use:
1. Print out the cards.
2. Cut along the dashed lines.
3. Fold along the solid lines.
Sample flash cards in this set:
| Questions | Answers |
|---|---|
| Description of Stable Angina | A symptom which results when myocaridal oxygen demand is greater than myocardial oxygen supply. Some pts may not be symptomatic |
| Risk Factors for Stable Angina | Family Hx of coronary artery disease Hypertension Hypercholesterolemia Diabetes Mellitus Tobacco/Cocaine Use Obesity Advancing Age |
| Types of Angina | Classic: Reproducible and predictable, no increase in frequency, severity, or duration Prinzmetal's: Results from coronary artery vasospasm; occurs in typical patterns Unstable: Recent onset, or an increase in severity, frequency or duration from usual, symptoms at rest, or nocturnal symptoms |
| Assessment Findings in Stable Angina | Change in symptoms warrants further investigation Heaviness, discomfort, pressure, pain, ache radiating to back, chest, arms,jaw, teeth May be precipitated by exercise, stress, cold temperature, ingestion of a heavy meal, and smoking Pain/discomfort relieved after nitro administration SOB with or without activity Asymptomatic Nausea Perspiration Palpitations |
| Diagnostic Studies in Stable Angina | EKG: may demonstrate ST segment changes Chest X Ray: New or Worsening CHF Lipid Level: May demonstrate hyperlipidemia ECHO Stress Test Coronary Angiography |
| Nonpharmacologic Management of Stable Angina | Cardiac Rehab if appropriate Modify coronary artery disease risk factors Adhere to antianginal medication schedule Stress Management Consumption of low fat diet Smoking Cessation Regular, Aerobic exercise Attain/maintain ideal body weight Pt education |
| Pharmacologic Management of Stable Angina | Nitroglycerin ACE Inhibitor Beta Blockers Calcium Channel Blockers ASA Statins |
| Nitroglycerin in Stable Angina | Produce arterial and venous dilation by relaxing vascular smooth muscle Tolerance develops; therefore a daily nitrate free period should occur Monitor for hypotension, palpations May produce severe HA |
| ACE inhibitors in Stable Angina | Suppress renin-angiotensin aldosterone system; Attenuate catecholamine release from adrenergic nerve endings Recommended for secondary prevention of MI Improves morbidity and mortality from MI |
| Beta Blockers in Stable Angina | Blocks beta receptors in heart which depresses myocardial contractility and decreases sympathetic stimulation Monitor for hypotension, bradycardia, and CHF Abrupt withdrawal can precipitate reflex tachycardia Can worsen symptoms of peripheral artery disease by decreasing cardiac output |
| Calcium Channel Blockers in Stable Angina | Depress myocardial contractility and increased cardiac blood flow Monitor for arrhythmias, hypotension Can cause ankle edema Significant interaction with Grapefruit Juice |
| ASA in Stable Angina | Prevent platelet aggregation and exert anti-inflammatory effect in vessels by inhibiting prostaglandin synthesis Monitor for bleeding, tinnitus, GI irritation Cautious use in asthmatics due to hypersensitivity reactions |
| Statins in Stable Angina | Inhibit HMG-CoA, the enzyme which is partly responsible for cholesterol synthesis Monitor for myopathy, rhabdomyolysis Monitor LFTs before starting and at 6 and 12 weeks, after dose increase, and periodically |
| Follow-up for Stable Angina | Depends on frequency and severity of symptoms Pts with stable angina should be clinically assessed every 4-6 months for the first year, then at least annually |
| Description of Acute Coronary Syndrome | A set of closely related disorders resulting in artheromatous plaque disruption within the coronary arteries and subsequent intravascular clot formation. Myocardial ischemia results that is sufficient to cause damage to the cardiac musculature |
| Classifications of Acute Coronary Syndrome (ACS) | Unstable Angina Non-ST segment MI ST segment MI |
| Risk Factors for ACS | Family hx of premature CAD (<60yrs) Hyperlipidemia Age (>40 men, postmenopausal women) Cigarette smoking Hypertension Sedentary Lifestyle Diabetes Mellitus Stressful Lifestyle |
| Assessment Findings in ACS | Ache, pain, tightness, discomfort, or pressure in chest, arm(s), jaw, teeth, epigastrium or neck usually lasting >20 min; Often unrelieved by nitro Escalating severity of angina Nausea, Vomiting, Diaphoresis Weakness, syncope Feeling on impending doom Hypertension/Hypotension Silent (occurs 20% of time, usually in women, diabetics, or elderly) |
| Diagnostic Studies for ACS | Troponin I: Detectable 3-6 hours after MI EKG: May show elevation/depression of ST segment; presence of Q waves CK-MB isoenzymes; presence in serum indicative of myocardial infarction Coagulation studies Chest X ray: Helps identify cardiomegaly, CHF, and pulmonary diseases which may mimic or exacerbate cardiac disease Anogiography: demonstrates narrowed coronary artery by atherosclerotic lesion ECHO |
| Nonpharmacologic Management of ACS | Re-establish coronary perfusion via angiographic/surgical means ASAP Low Na, low fat diet Patient Education regarding disease, treatment, lifestyle changes, medications |
| Pharmacologic Management of ACS | Acute Phase: IV thrombolytics, Heparin, ASA, anticoagulants, Nitrates, Beta Blockers, Antiarrhythmias, Oxygen, Analgesics Post-MI: BBs, ACEI, Statins and/or fibrates or niacin, nitrates as needed, anticoagulants/antiplatelets |
| Nitroglycerin in ACS | Produce arterial and venous dilation by relaxing vascular smooth muscle Tolerance develops May produce severe HA Monitor for hypotension, palpitations |
| ACE Inhibitors in ACS | Suppress renin-angiotensin aldosterone system; Attenuate catecholamine release from adrenergic nerve endings Recommended for secondary prevention of MI |
| Beta Blockers in ACS | Block beta receptors in the heart which depress myocardial contractility and decreases sympathetic stimulation Monitor for hypotension, bradycardia, and CHF Abrupt withdrawal can precipitate reflex tachycardia Can worsen symptoms of peripheral artery disease by decreasing cardiac output |
| Calcium Channel Blockers in ACS | Depress myocardial contractility and increase cardiac blood flow Monitor for arrhythmias, hypotension, ankle edema Interacts with grapefruit juice |
| Statins in ACS | Inhibit HMG-CoA, the enzyme which is partly responsible for cholesterol synthesis Monitor LFT at start, 6 and 12 wks, and with dose increase Watch for myopathy, rhabdomyolysis |
| ASA in ACS | Prevent platelet aggregation and exerts anti-inflammatory effect in vessels by inhibiting prostaglandin synthesis Monitor for bleeding, tinnitus, GI irritation Caution with use in asthmatics due hypersensitivity reactions |
| Follow-Up for ACS | Per Cardiologist Encourage participation in cardiac rehab program |
| Consultation for ACS | Immediate referral to ED, Give O2, ASA, Nitro, and transport pt) |
