Clinical Manifestations -Chest pain is transient in nature and usually is relieved with rest or nitrates -Pain can range from sensation of heaviness/pressure to moderately severe pain. -Sensation of a clenching fist over left sternal border. -may be mistaken as indigestion -Pain may radiate to neck, lower jaw, left arm/shoulder, back or down the right arm -Pallor, diaphoresis & dyspnea may be present -Women may have atypical chest pain, palpitations, sense of unease of severe fatigue. Clinical Implications -if demand is decreased, no necrosis of myocardial cells will occur. -pain is caused by a buildup of lactic acid or abnormal stretching of ischemic myocardium. -Lack of relief with rest indicates patient may be developing an infarction. Prinzmetal Angina Persons at Risk Smokers, men more than women, common among Japanese people, those younger in age (51- 57 years old) Etiology Vasospasm -Pain is caused by vasospasm of one or more of the coronary arteries, with or w/o atherosclerosis. Clinical Manifestations Chest pain may occur unpredictably, usually at rest, typically at night, during rapid eye movement sleep & may have cyclic pattern of occurrence. -May or may not be associated w/ atherosclerosis -Serum markers CRP and IL-6 may be elevated Clinical Implications 15
-Causes: decreased vagal activity, hyperactivity of SNS, decreased nitric oxide activity, altered calcium channel function in arterial smooth muscle, endothelial dysfunction with release of inflammatory mediators (serotonin, histamine, endothelin or thromboxane) -usually successfully treated with vasodilators* Silent Ischemia Persons at Risk Diabetics; more common in women Etiology Myocardial ischemia Clinical Manifestations Fatigue, dyspnea, or feelings of unease -detected using stress radionucleotide imaging. Clinical Implications -Mental stress has been linked to increased markers of inflammation, such as CRP, decreased vasodilators & hypercoagulable states. -Stress management is important f. Differentiate between the three types of acute coronary syndrome (unstable angina, NSTEMI, STEMI) and their clinical manifestations. Unstable Angina Definition -form of ACS that results from reversible myocardial ischemia and signals that atheroscleotic plaque has ruptured and infarction may soon occur. -Is chest pain that is prolonged or recurrent chest pain at rest, or angina which is increasing in severity or frequency. Clinical Manifestations -Can progress to NSTEMI or STEMI NSTEMI Definition Myocardial infarction which results from a thrombus which has occluded coronary blood flow for greater than 20 minutes and results in myocardial necrosis in the myocardium directly below the endocardium Clinical Manifestations -ST depression -T wave inversion STEMI Definition Myocardial infarction that occurs when blood flow is interrupted for an extended period, causing necrosis and is accompanied by ST elevation on ECG.
You've reached the end of your free preview.
Want to read all 26 pages?
- Fall '15
- Spring 2018