So let’s look at this in a nutshell. There's three main types of chest pain.
Before you see the answer, I’d like you to try and write the names of the three types of chest pain in the margin of your notes.
Chronic stable angina, variant angina, and unstable angina.
Now, circle the one, whether in your notes or on this slide, that’s the medical emergency.
Great! It’s unstable angina. I mean not great, if you have unstable angina but if you’ve got that answer, good work.
Now, which one of those is caused by vasospasms? Put a star by that one. Good work!
It’s variant angina or Prinzmetal’s angina whichever you wanna call it.
Now the four types of medication that are used to treat angina, can you write those in your notes without looking?
Survey says -- nitrates, calcium channel blockers, beta blockers, and our newest friend, ranolazine.
Okay, for acute unstable angina treatment, don’t think of that as United States of America,
that is unstable angina treatment, for sure gonna be against ischemia, so we're gonna look at nitroglycerin,
beta blockers, oxygen, ACE inhibitors or ARBs if they can't tolerate the ACE inhibitor.
Now in the margin of your notes I want you to remind us of when we would use oxygen,
what are two guidelines we would use oxygen for as the one presented in acute attack?
Cool! I hope you got that if their sat was less than 90%
or the patient were showing you other signs of respiratory distress or hypoxemia -
low oxygen in your blood. Good work! You worked hard on this!
And a platelet therapy were against platelets grouping together, so aspirin and some of the other antiplatelets but remember,
we always want you to remember, aspirin at the minimum and you have the other antiplatelets listed in your notes.
Now, for anticoagulant therapy, I wanna start with a question, what's the difference in the monitoring
that has to be done for low molecular weight heparin and unfractionated heparin?
Great, I hope you got that we do not have to do lab work for low molecular weight heparin.
We do have to draw aPTT for unfractionated heparin and watch that lab work closely
to make sure that the patient really isn't getting into the increased risk for bleeding.
Now the other medication in anticoagulant therapy is direct thrombin inhibitors.
It inhibits the amount of thrombin which is a good idea because that’s what causes those clots to really stick together.
Now lastly, consider thrombolytic therapy after you diagnose the patient,
you ruled out any contraindications that may be something else that we would use.
So in acute treatment, we're looking for anti-ischemic, antiplatelet, anticoagulant
and possibly thrombolytic therapy if the patient is appropriate
and we've done our due diligence in making sure that they are as safe as possible before we administer the medication.
Thank you for watching our video today.