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88 Cards in this Set
- Front
- Back
What is temporal arteritis?
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Progressive inflammatory disorder of cranial blood vessels, principally the temporal artery
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What is another name for temporal arteritis?
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Giant Cell Arteritis
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What is a giant cell?
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an abnormally large tissue cell; it often contains more than one nucleus and may appear as a merger of several normal cells
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What is a coarctation?
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A compression, shrivelling, or stricture of the walls of a vessel as the aorta
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What is coarctation of the aorta?
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Coarctation of the aorta is a congenital cardiac anomaly characterized by a localized narrowing of the aorta. It results in increased pressure proximal to the defect and decreased pressure distal to it.
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What is the most common site for coarctation of the aorta?
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The most common site for coarctation of the aorta is just beyond the origin of the left subclavian artery from the aorta.
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In what part(s) of the body does a coarctation of the aorta cause HIGH blood pressure?
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In the upper extremities and the head.
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In what part(s) of the body does a coarctation of the aorta cause LOW blood pressure?
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In the lower body and extremities.
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What are the symptoms of coarctation of the aorta?
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- fatigue in legs
- high blood pressure - cold legs, feet - decreased exercise performance - heart failure |
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What is the most common type of coarctation?
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Postductal coarctation, in which the constriction lies at or just distal to the obliterated ductus arteriousus (the ligamentum arteriosum)
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What is pre-ductal coarctation?
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Pre-ductal constriction lies in the aortic isthmus, i.e., the segment of aorta between the left subclavian artery and the point of entry of the ductus arteriosus.
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When (at what age) does post-ductal coarctation usually present?
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Late childhood or adulthood
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When (at what age) does pre-ductal coarctation usually present?
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In infancy
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How often do coarctations occur alone vs. in association with other malformations, e.g., ASD, VSD
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50% of the time
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How does left ventricle hypertrophy appear on an ECG?
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The depth of the downward S-wave in lead V1, plus the height of the upward R-wave in lead V5 equals more than 35 mm.
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What does "strain" indicate in "left ventricular hypertrophy with strain"?
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The left ventricle is working hard against something…(systemic hypertension, an aortic stenosis, coarctation of the aorta?)…and the chronic strain has caused it to hypertrophy
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How is left ventricular strain diagnosed on an ECG?
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There is asymmetric ST-segment depression in lead V5. The asymmetry of this inversion is a long and gradual downslope, followed by a shorter, more abrupt upslope.
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How is right ventricular strain diagnosed on an ECG?
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An asymmetric T-wave inversion would in lead V2 (instead of V5 for left ventricle).
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What effect can a coarctation have on the ribs?
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A coarctation can cause rib notching.
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What ribs may be notched by a coarctation?
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4th - 8th ribs
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Is a coarctation the only thing that can cause rib notching?
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No. There are other diseases, including neurofibromatosis, in which enlarged nerves erode the bone.
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Below what artery does an aortic aneurysm frequently occur?
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Below the renal artery.
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What is an aneurysm?
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An aneurysm is a localized dilation of the wall of a blood vessel.
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What is an aortic aneurysm?
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dilation of the wall of the aorta caused by atherosclerosis, hypertension, or, less commonly, syphylis.
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What is aortic dissection?
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Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta. This most often occurs because of a tear or damage to the inner wall of the artery.
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Who are the most common sufferers of aortic dissection?
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40 - 70 yo men
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Do symptoms of aortic dissection begin slowly or suddenly?
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Suddenly
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What is the chief complaint of a person with aortic dissection?
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A "tearing" feeling in the middle of the chest.
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Aortic dissection is common in patients with which two type of hereditary connective tissue diseases?
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Marfan's syndrome and Ehler-Danlos syndrome
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What is Marfan's syndrome?
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a hereditary condition that affects the musculoskeletal system and is often associated with abnormalities of the cardiovascular system and of the eyes.
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What is Ehlers-Danlos syndrome?
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It is a hereditary disorder of conective tissue, marked by hyperplasticity of skin, tissue fragility, and hypermotility of joints.
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What is atherosclerosis?
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Narrowing and hardening of the arteries due to plaques of fats, cholesterol, and cellular debris
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What are the risk factors for atherosclerosis?
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- Age
- Sex - women more protected by estrogen - Family, genetics |
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What is arteriosclerosis?
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Pathologic thickening, hardening, and loss of elasticity of arteriolar walls (usually comes with age)
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What is angina?
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Intermittent chest pain due to myocardial ischemia due to less than normal coronary blood flow
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What is intermittent claudication?
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Cramplike pains in the calves caused at times by poor circulation of blood to the leg muscles. Commonly associated w/atherosclerosis.
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When do angina and claudication occur, i.e., what's missing from the affected tissue?
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The tissue has an insufficient supply of O2.
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How is blood flow related to a blood vessel's radius.
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Blood flow is directly proportional to the radius to the 4th power, r4.
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Why is angina intermittent?
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The supply of O2 to the tissue may be sufficient for resting conditions.
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What is stable angina?
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Angina in which attacks occur w/ predictable frequency and duration and are precipitated by circumstances, such as exercise or emotional stress, that increase myocardial O2 demands.
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What is variant angina?
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Chest pain caused by reversible, severe coronary artery spasm which causes temporary stenosis.
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What is another name for variant angina?
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Prinzmetal's angina
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When does variant angina often occur?
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At rest (may awaken patient at night).
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Who is a typical sufferer of variant angina?
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Women under 50 yo.
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What is unstable angina?
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Acute change in atherosclerotic plaque and adherent partial thrombosis which make stenosis worse.
Compared to stable angina: 1. less exertion causes more pain 2. pain lasts longer time 3. attacks are more frequent |
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What are 4 causes of stable angina?
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1. fixed atherosclerotic stenosis of one or more coronary arteries
2. aortic stenosis 3. aortic regurgitation 4. myocardial hypertrophy |
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How long do stable angina attacks usually last?
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3 - 20 minutes
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What sort of terms does a patient use when describing the substernal sensation of stable angina?
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- pressure
- crushing - tightness - burning - squeezing - vague pain |
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What % stenosis of a coronary artery qualifies as "critical stenosis"?
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75%
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Where does the sensation of angina begin?
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- Back of neck
- Lower jaw - Interscapular area |
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Where may the sensation of angina radiate?
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- left shoulder, upper arm
- inner aspect of elbow, forearm, wrist, or 4th & 5th fingers |
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When may threshold for pain of angina be lowered?
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- After meals
- When excited - When exposed to cold |
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What dermatomes are typically referred to by angina?
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C8 - T4; however, jaw and neck are not in this range, but may be affected.
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What are some differential diagnoses for anginal type pain?
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- dissecting aortic aneurysm
- pulmonary embolism - pneumothorax - pneumonia - esophageal spasm - GERD, peptic ulcer, cholecystitis (gall bladder) - chest wall pain (inflam of costochnodral joints) - cervical or thoracic radiculopathy (disease involving a spinal nerve root) |
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What can be administered to (not) diagnose angina?
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Nitrate will relieve the pain if it IS angina.
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Does BP increase or decrease during an anginal attack?
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BP may do either.
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What unusual heart sound might you hear during an angina attack?
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An apical systolic murmur
- due to mitral regurg - due to papillary muscle ischemia |
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What are 4 historical signs of angina?
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- diabetes
- HTN - PAD - xanthelasma (lipid plaques on eyelid) |
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What lab tests may be ordered for angina?
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- serum (cardiac) lipids
- resting, anginal ECG's - stress test - coronary angiography |
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What will a coronary angiography of an anginal patient show?
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Stenosis of left anterior descending (LAD) coronary artery and/or its branches
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What is the treatment for an acute angina attack?
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sublingual nitroglycerin
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How do nitrates affect afterload?
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They cause arteriolar dilation ->
decreased TPR -> decreased afterload |
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How do nitrates affect preload?
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They cause venous dilation ->
decreased venous return -> decreased preload |
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How do decreased afterload and decreased preload affect ventricular work and O2 demand?
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They decrease the demand for ventricular work and for O2.
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What existing conditions should be treated in an angina patient?
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HTN and high LDL
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What types of drugs can be prescribed as prophylaxis for angina?
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- long-lasting nitrates
- beta-blockers - calcium-channel blockers - antiplatelet agents |
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How do beta blockers work (against angina)?
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They decrease heart rate and contractility which decreases the demand for O2.
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How do calcium-channel blockers work (against angina)?
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- They decrease heart rate and contractility
- They cause coronary dilation which allows for better blood flow. |
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What is a common antiplatelet agent and how is it used as a prophylaxis for angina?
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Aspirin. It destroys platelets or inhibits their function (clotting) -> prevents coronary thrombosis
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What are 2 coronary revascularization procedures that can be used in the treatment of angina?
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1. coronary artery bypass grafting - CABG
2. percutaneous transluminal coronary angioplasty - PTCA |
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What is the cause of variant/prinzmetal angina?
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The cause is unknown. It is NOT triggered by exertion.
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How do the symptoms for variant/prinzmetal angina compare to those for stable angina?
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The symptoms are the same.
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What does an ECG show for variant/prinzmetal angina?
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Usually ST segment elevation
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What does a coronary angiography typically show for variant/prinzmetal angina?
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- NO fixed stenoses
- Right coronary artery involvement (spasm) |
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What types of drugs are used to treat variant/prinzmetal angina -- acutely or prophylactically?
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Calcium channel blockers and nitrates
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What are two specific drugs that are used to treat variant/prinzmetal angina?
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1. Cardizem (diltiazem)
2. Verelan (verapamil) |
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What are 2 other names for unstable angina?
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Crescendo or preinfarction angina
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What is unstable angina a warning for?
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An impending, irreversible ischemic event
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What does an ECG show for unstable angina?
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Usually, ST segment depression during attacks.
Sometimes, ST segment elevation. |
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What are non-drug treatments for someone with unstable angina?
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- hospitalization
- bed rest - limited activity - supplemental O2 |
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What types of drugs are used to treat unstable angina?
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- nitrates
- antiplatelet agents (aspirin) - anticoagulation therapy: nonfractionated (NL) heparin or low molecular weight (fractionated) heparin |
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Compared to stable angina, how does unstable angina respond to nitrates.
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Unstable angina does not respond to nitrates as well as stable angina.
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What is the etiology of Acute Myocardial Infarction (AMI or heart attack)?
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Fixed coronary atherosclerotic plaque causing critical stenosis +
acute plaque changes and/or coronary artery thrombosis |
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What are some examples of acute plaque changes?
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- fissuring
- hemorrhage into the plaque - plaque rupture w/ embolization of debris - thrombus from fissuring or hemorrhage - complete occlusion w/angina so bad that it constitutes a heart attack |
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What accounts for AMI's in previously asymptomatic patients?
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acute plaque changes
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How is a coronary artery thrombosis formed?
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By plaque fissuring or rupture, exposing platelets to thrombogenic plaque lipids and thrombogenic subendothelial collagen
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How does a coronary artery thrombosis lead to unstable angina?
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It partially occludes a blood vessel.
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How does a coronary artery thrombosis lead to an AMI?
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It completely occludes a blood vessel.
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