10 - Angina Flashcards
Causes of Angina
Decrease in myocardial O2 supply (Coronary artery disease, severe anaemia)
Increased Myocardial O2 demand (Left ventricular hypertrophy, right ventricular hypertrophy)
Indications for cardiological referral
New onset angina Recurrent angina Angina in MI patients Occupational fitness Worsening Angina
Diagnosis of Angina
History
Non-invasive investigation - Exercise ECG
Imaging - Isotope perfusion, Echo, CT calcium scoring and angiography
*Reversible myocardial ischaemia or anatomical coronary artery disease to diagnose
What do you look for in history of Angina
Character, Location, Radiation, Duration, Provocation
What are diagnosti features on an ECG of angina?
Downsloping ST depression
How to increase O2 delivery
Increase coronary flow with nitrates, CaB, Nicorandil and revasc
How to reduce O2 demand
Decrease heart rate with BB, ivabridine
Decrease LV wall tension with nitrates, nicorandil, caBs and ranolazine
Decrease contractility with BB and CaBs
Modify energy metabolism with trimetazidine
How do you manage angina
Specialist referral
- β blocker ± CAB
- sublingual GTN
- aspirin, statin, ±ACE-I
- lifestyle modification
If resolution of angina then no further investigation
If continuing angina then cardiac catheterisation, PCI or coronary bypass surgery
What is PCI
percutaneous coronary interventions
Uses a catheter to place a stent to open up blood vessels in the heart
What is CABG
Coronary artery bypass grafting
A surgery that improves blood flow to the heart
What are the diagnostic criteria for angina
Central chest discomfort lasting 5-15 minutes
Provoked by exertion or emotional stress
Relieved by rest or nitrates
What is angina
Stable coronary disease
Painful sensation in the breast
Seized when walking
(especially up a hill + soon after eating) - EXERTION
Causes of LVH
Hypertension
Aortic stenosis
Aortic regurgitation
Hypertrophic cardiomyopathy
Causes of RVH
Pulmonary hypertension
Pulmonary stenosis
