Stable Angina Pectoris

• MI/unstable angina covered in emergencies/urgencies
• Etiology/Risk Factors
  • Lifestyle/diet
  • Genetic
  • Smoking
  • Hyperlipidemia
• Pathophysiology
  • Imbalance of coronary O₂ blood supply and demand resulting in chest pain from myocardial ischemia
    • Determinants of supply
      • Oxygen‐carrying capacity of blood
      • Degree of oxygen unloading from hemoglobin
      • Coronary artery blood flow (Figure 6.6)
    • Determinants of demand
      • Heart rate
      • Afterload
      • Myocardial wall tension
      • Contractility
  • Stable angina should be relieved with rest and, if needed, nitroglycerin
• Treatment
  • Lifestyle/diet modifications
  • Antiplatelets
    • Aspirin
    • Clopidogrel
  • Nitrates, long acting
  • Nitroglycerin
  • β‐blockers
  • Calcium channel blockers
  • Revascularization
    • CABG
    • PCI stent
• Primary Concerns
  • ↑ Risk of MI
  • Current antiplatelet medications
  • Previous PCI
• Evaluation
  • Consider cardiologist consult
  • Consider preoperative ECG
    • May be normal when patient is asymptomatic
  • Consider echocardiogram
  • Establish DASI/METs on pages 67–68
  • History
    • Provoking factors
    • Alleviating factors
    • Duration of pain discomfort
    • Last time patient had symptoms
    • Previous interventions
• Anesthesia Management
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