126 - Chronic, stable angina Flashcards
What is Angina?
Retrosternal chest pain/pressure
Occurs during exertion
Describe ECG during angina attack
ST depression
What relieves angina?
Rest/GTN spray
Short term control of angina symptoms
Prescribe sublingual GTN spray - show patient how to use.
Long term prevention of angina symptoms
Treat with Beta blocker unless contraindicated.
Patient must not stop suddenly/allow to run out of drug.
Purpose of aspirin for angina patients?
Clot prevention
Purpose of simvastatin for angina patients
Lower cholesterol
Purpose of GTN for angina patients
Vasodilator
Purpose of B-blocker for angina patients
Vasodilator
Purpose of CCB for angina patients
Vasodilator
When is angina stable?
Symptoms occur only after exertion and subside in minutes
When is angina unstable
Symptoms occur unpredictably Treat as an emergency.
Describe the levels of the Canadian Cardiovascular Society Angina Grading System
Grade 1 - only during strenuous activity.
Grade 2 - Slight limitation. Climbing stairs.
Grade 3 - Marked limitation - walking on level.
Grade 4 - Angina at rest or all activity causes angina.
Risk factors for angina
Smoking
Diet
Hypertension
Also - FH, hyperlipidemia, DM, Obesity, sedentary lifestyle, age, M>F (before menopause)
Myocardial ischaemia caused by:
Insufficent supply or high demand.
What is Decubitus angina
Occurs when lying flat. Generally related to heart failure.
What is Prinzmental’s angina
Caused by coronary artery spasm
Signs/symptoms of angina
Pain - reterosternal, crushing, radiating, stops within minutes of exertion stopping
Dyspnoea
Added heart sounds during ischemia
Differential dx for angina
Reflux, PE, aortic dissection, shingles.
Investigations for Angina
Bloods - FBC, U&Es, Glucose, Lipids, TFTs, LFTs, Troponin (if ECG changes)
ECG - expect ST depression
Echo if hypertrophic cardiomyopathy/aortic valve suspected
Assessment of coronary artery disease
Based on clinical assessment.
Risk factors/age
Estimate risk to determine need for further investigations.
2 types of treatment for Angina
Risk modification - lifestyle
Pharmacological
