Ischemia

An insufficient supply of oxygen that leads to tissue damage or death

Causes

Atherosclerosis
Constriction of arteries
Emboli
Bleeding ( low blood volume)

Risk Factors

Stress
Atypical increase in activity
Male
Increasing age
Smoking
Obesity
Family history
HTN
DM
Inactivity
Dyslipidemia
Cocaine use

Clinical Presentation

Angina
- Crushing chest pain and a feeling of impending doom!
- Midsternal pain which may radiate to jaw, neck, shoulder and down the left arm.
- Stable angina
  - Brought on with physical activity and relieved with rest
  - Usually resolves within 30 minutes
- Unstable angina/non ST elevation myocardial infarction
  - Increasing chest pain. Occurs at rest or with exercise.
- Prinzmetal’s angina also known as variant angina
  - Vasospasm of the coronary arteries
  - Not affected by activity
  - Beta blocker is contra indicated
Levine’s Sign – Clenched fist held over the heart

Labs and Studies

ECG
- ST depression
- Downsloping ST
Exercise ECG – An ST depression of 1 mm is a positive test
Echo – to view left ventricular function
Cardiac catheterization – diagnostic
Troponins – rule out MI

Treatment

Begin dealing with risk factors
- Weight reduction
- DM under control
- Quit smoking
- HTN under control
- Lipid panel under strict control
- Exercise
Medical
- Sublingual nitroglycerin or isosorbide dinitrate (emergently)
  - Potent vasodilator should bring about immediate relief
  - Side effects
    - Hypotension
    - Headaches
    - N/V
- Long acting nitrates
  - Require several hours a day treatment free to keep in order to maintain efficacy.
  - Side effects
    - Hypotension
    - Headaches
    - N/V
- β- blockers
  - Shown to prolong life in patients with CAD
  - FIRST LINE therapy for chronic angina, but contraindicated in Prinzmetal’s angina
  - Blunt the heart’s response to epinephrine and norepinephrine
- Calcium Channel Blockers
  - Decrease contractility of heart
  - Decrease peripheral vascular resistance
- Blood thinners
  - Aspirin 81 mg or 325 mg daily
  - Clopidogrel (Plavix)
Surgical
- Revascularization
  - Balloon Angioplasty and stents
  - Coronary artery bypass grafting (CABG)

Study tip

Carol Dweck’s book Mindset.

Growth vs fixed mindset
You have permanent traits and this program/test is designed to judge them them or you are a developing person
You are a finished product or your still growing and learning.
and improving and

Phillip who was working on a project with his father when he spilled a bucket of nails.
Phillip “I’m so clumsy.”
Dad “That’s not what we say when the nails spill”
Phillip “What do we say?”
Dad “We say, the nails spilled and I’ll clean them up.”

Check out her TED talk here. Invest the 10 minutes and 20 seconds. The returns may be life changing.

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