ANGINA

 

Etiology:

  1. similar  to MI ( see below).

S & S :

  1. similar  to MI ( see below ).

Classification :

  1. Chronic - exercise induced, similar pattern to previous attacks, relived  by Nitro.
     
  2. Unstable - new onset ( up to 6 - 8 weeks ) or change in pattern from previous attacks or  C.P. at rest.
     
  3. Prinzmetal - occurs 2ry to coronary spasm rather than occlusion, occurs at rest, EKG shows ST­.

DX:

  1. Most important is history.
     
  2. Elevated CPK/MB after 8-24 hrs and elevated Troponin after 6 hrs from the onset of chest pain. 
     
  3. Some pts may have EKG changes during acuity and can normalize with SL Nitro.
     
  4. Note that occasionally pt may present with angina pain not amenable to Nitro (IV or PO). This pt may have a small vessel disease that does not respond well to Nitro.

Labs:

  1. CBC, SMA, PT/PTT, CPK, T & X (type & cross), Troponin I.

Treatment:

  1. 2% O2 via NC
     
  2. Salicylates (Aspirin) 165mg or 325mg
     
  3. Nitroglycerin in SL, Paste or IV form if pain is present
     
  4. b-Blockade with 5mg metoprolol (Lopressor) IV q2-5min up to 15mg. This done in order to ¯ HR to 60bmp and the BP by decreasing of adrenergic  activity. It was shown to be more beneficial than Nitro in reducing mortality and reinfarction rate.
     
  5. Heparin: 80 U/kg IV bolus followed by 25000 U in 250 ml D5W @ 18 U/kg/h IV infusion.
     
  6. Enoxaparin (Lovenox) is also commonly used 30-60 mg SQ q12hr. Patient on this medication doesn't need  PT/PTT checked. Problem is that because of prolonged T1/2, if patient needs to go to cath-lab STAT, it may interfere with prolonged bleeding.
     
  7. Ca Channel Blocker is given in Prinzmetal's angina.
     
  8. Recently a new anti-platelet aggregate, Aggrastat, was introduced to use along side Heparin and ASA for treatment of angina.

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