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angina - Management of Stable Angina Pectoris David Putnam...

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Management of Stable Angina Pectoris David Putnam, MD Albany Medical College
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Angina Pectoris Classic angina is characterized by substernal squeezing chest pain, occurring with stress and relieved with rest or nitroglycerin. May radiate down the left arm May be associated with nausea, vomiting, or diaphoresis.
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Angina
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Stable Angina Classification Exertional Variant Anginal Equivalent Syndrome Prinzmetal’s Angina Syndrome-X Silent Ischemia
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Angina: Exertional Coronary artery obstructions are not sufficient to result in resting myocardial ischemia. However, when myocardial demand increases, ischemia results.
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Angina: Variant Angina Transient impairment of coronary blood supply by vasospasm or platelet aggregation Majority of patients have an atherosclerotic plaque Generalized arterial hypersensitivity Long term prognosis very good
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Angina: Anginal Equivalent Syndrome Patient’s with exertional dyspnea rather than exertional chest pain Caused by exercise induced left ventricular dysfunction
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Angina: Prinzmetal’s Angina Spasm of a large coronary artery Transmural ischemia ST-Segment elevation at rest or with exercise Not very common
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Angina: Syndrome X Typical, exertional angina with positive exercise stress test Anatomically normal coronary arteries Reduced capacity of vasodilation in microvasculature Long term prognosis very good Calcium channel blockers and beta blockers effective
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Angina: Silent Ischemia Very common More episodes of silent than painful ischemia in the same patient Difficult to diagnose Holter monitor Exercise testing
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Angina: Treatment Goals Feel better Live longer
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Angina: Prognosis Left ventricular function Number of coronary arteries with significant stenosis Extent of jeoporized myocardium
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Stable Angina Risk stratification Noninvasive testing Cardiac catheterization
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Stable Angina Evaluation of LV Function Physical exam CXR Echocardiogram
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Stable Angina Evaluation of Ischemia History Baseline Electrocardiogram Exercise Testing
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CCSC Angina Classification Class I Class II Class III Class IV Angina only with extreme exertion Angina with walking 1 to 2 blocks Angina with walking 1 block Angina with minimal activity
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Stable Angina Exercise Testing The goal of exercise testing is to induce a controlled, temporary ischemic state during clinical and ECG observation
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Angina: Exercise Testing
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Angina: Exercise Testing High Risk Patients Significant ST-segment depression at low levels of exercise and/or heart rate<130 Fall in systolic blood pressure Diminished exercise capacity Complex ventricular ectopy at low level of exercise
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