IHD Patho 2012_Student Version (2)

Variant angina potential mechanism for vasospasm

Info icon This preview shows pages 53–68. Sign up to view the full content.

View Full Document Right Arrow Icon
Variant Angina Potential mechanism for vasospasm Hyperactive sympathetic nervous system Defect in handling of calcium in vascular smooth muscle Alteration in nitric oxide production Imbalance between endothelium derived relaxation and contracting factors
Image of page 53

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Silent Myocardial Ischemia Ischemia is present, but anginal pain does NOT occur Patients typically have: Altered pain threshold Autonomic neuropathy Can occur in: Elderly Diabetics
Image of page 54
Differential Diagnosis Pericarditis Esophageal reflux / peptic ulcer disease Aortic dissection Pulmonary embolism Biliary disease Musculoskeletal disease
Image of page 55

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Patient History Detailed history of chest pain Nature Precipitating factors Duration Radiation Response to rest/SL NTG Assess risk factors
Image of page 56
Spectrum of CHD
Image of page 57

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Acute Coronary Syndrome Non-ST-Segment Elevation ACS NSTE ACS ST-Segment Elevation ACS STE ACS Unstable Angina UA Non-ST Segment Elevation Myocardial Infarction NSTEMI ST Segment Elevation Myocardial Infarction STE MI
Image of page 58
Acute Coronary Syndrome Results primarily from diminished myocardial blood flow secondary to completely occlusive or partially occlusive coronary artery thrombus Due to plaque rupture
Image of page 59

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
ACS Stable Angina versus Stable Angina versus ACS ACS
Image of page 60
Acute Coronary Syndrome NSTE ACS Thrombus produces incomplete occlusion of coronary lumen ECG changes ST-segment depression T-wave inversion No changes No Q waves Cardiac biomarkers NSTE MI (+) UA (-) STE MI Thrombus completely occludes coronary lumen ECG changes ST-segment elevation Q-waves may also develop Transmural necrosis Cardiac biomarkers (+)
Image of page 61

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
STE MI = Complete Coronary  Occlusion Photo adopted from:
Image of page 62
Clinical Presentation of ACS Midline anterior anginal chest discomfort Quality and radiation similar to chronic stable angina Longer duration usually > 20 minutes Patients with UA present with: Angina at rest Severe, new-onset (< 2 mo) angina Angina increasing in frequency, duration, or intensity Patients with NSTE MI or STE MI usually have prolonged, more intense rest angina Often not relieved with sublingual nitroglycerin
Image of page 63

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Accompanying Symptoms Dyspnea Weakness Diaphoresis N/V Some patients less likely to present with classic symptoms Elderly, women, patients with diabetes
Image of page 64
Accompanying Signs No signs are classic for ACS Patients may present with signs of acute heart failure Jugular venous distension Rales – (+) S 3 3 rd heart sound that is not normally present May also present with arrhythmias
Image of page 65

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Diagnostic Tests Electrocardigram (ECG) Laboratory tests Cardiac biomarkers Coronary angiography “Cardiac catheterization” Echocardiography Stress testing
Image of page 66
Electrocardiogram (ECG) Photo adopted from: One cardiac cycle: sinoatrial (SA) node Bachmann’s bundle
Image of page 67

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 68
This is the end of the preview. Sign up to access the rest of the document.

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern