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Year 3: Medicine Block CARDIORESPIRATORY year 5 > Angina > Flashcards

Angina Flashcards

1
Q

What are the classification of Angina?

A
  • Classical Angina
  • Unstable angina
  • Refractory Angina
  • Vasospastic or Variant angina
  • Microvascular Angina
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2
Q

What is classical angina?

A
  • Characterised by chest pain described as heavy, tight or gripping.
  • Typically, pain is central/retrosternal and may radiate to jaw and/or arms.
  • Pain tends to occur with exercise or emotional stress or when walking up close in cold weather and eases rapidly with rest
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3
Q

What is Unstable Angina?

A
  • Refers to angina of recent onset (<24h) or deterioration in previous stable angina with symptom frequently occurring at rest.
  • Acute coronary syndrome
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4
Q

What is Refractory Angina?

A

Patient with severe coronary disease in whom revascularization is not possible and angina not controlled by medical therapy

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5
Q

NICE defines angina as:

A
  1. Constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
  2. Precipitated by physical exertion
  3. Relieved by rest or GTN in about 5 minutes
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6
Q

How do you label patient based on the NICE definition of Angina?

A
  • Patients with all 3 features have typical angina
  • Patients with 2 of the above features have atypical angina
  • Patients with 1 or none of the above features have non-anginal chest pain
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7
Q

What do you look for on examaination for Angina?

A
  • S4 sound may be heard
  • Sign suggesting anaemia, thyrotoxicosis or hyperlipidaemia (lipid arcus, xanthelasma, tendon xanthoma)
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8
Q

What are diagnostic investigations of Angina?

A

1st Line: CT angiography

2nd Line: Non-invasive functional testing

  • Use MPS with SPECT or Stress Echocardiography
  • First pass contrast-enhanced magnetic resonance perfusion
  • MRI for stress induced wall motion abnormalities

3rd Line: Invasive Coronary Angiography

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9
Q

What are other investigations of Angina?

A
  • Blood test
    • TFTs
    • Fasting Glucose, HbA1c
  • Fasting Lipid Progile
  • Glomerular Filtration
  • Troponin if unstable
  • 12 lead ECG
  • Chest XR
  • Echocardiography
  • Diastolic Function, alternative causes to chest pain
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10
Q

What agents are used for non-invasive functional testing?

A
  • Use adenosine, dipyridamole or dobutamine as stress agents for MPS with SPECT
  • Adenosine or dipyridamole for first pass contract MR perfusion
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11
Q

What is lifestyle advice for Angina?

A
  • Exercise
  • Smoking cessation
  • Diet
  • Weight control
  • Psychological support and offer interventions if necessary
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12
Q

How is symptomatic pain relief provided in Angina?

A

Offer a short-acting nitrate to prevent and treat episodes of angina

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13
Q

What are the general guidelines of Angina treatment?

A
  • One or Two anti-anginal drugs as necessary plus
  • Drugs for secondary prevention of cardiovascular disease.
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14
Q

What is the optimal drug treatment of Angina?

A

First line: Beta-blocker or Calcium Channel Blocker. Switch medication or use a combination of both if uncontrolled

If drugs are contraindicated or not tolerated, consider mono therapy or adding one drug using one of the following

  • Long-acting nitrate (isorbide mononitrate)
  • Ivabradine
  • Nicorandil
  • Ranolazine
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15
Q

What is done for patients whose angina isn’t controlled by two anti-anginas drugs?

A
  • Needs referral to cardiology
  • Third Anti-anginal drug whilst awaiting specialist review
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16
Q

When should third anti-anginas drugs be prescribed?

A

-The person’s symptoms are not satisfactorily controlled with two anti-anginal drugs and -The person is waiting for revascularisation or revascularisation is not considered appropriate or acceptable.

17
Q

What is the secondary prevention of Angina?

A
  • Consider Antiplatelet treatment in all people with stable angina taking into account the person’s risk of bleeding and co-morbidities. For most people this is low dose aspirin
  • Consider treatment with an ACE inhibitor for people with stable angina and Diabetes mellitus
  • Offer a Statin and Antihypertensive treatment
18
Q

When should revascularization be initiated?

A
  • Consider in people whose stable angina is not controlled with optimal medical treatment.
  • Offer coronary angiography to guide treatment strategy
  • Treatment options:
    • Coronary artery bypass grafting
    • Percutaneous coronary intervention.
19
Q

When is CABG better?

A

CABG is better for patient who have multivessel disease that isn’t controlled with medical treatment and have:

  • Diabetes or
  • Are over 65 or
  • Have anatomically complex three-vessel disease, with or without involvement of left main stem
20
Q

What should all patient with an NSTEMI receive?

A
  • Aspirin 300mg
  • Ticagrelor or Prasugrel
  • Nitrates or Morphine to relieve chest pain if required
21
Q

What is antithrombin treatment for patients with NSTEMI?

A
  • Fondaparinux should be offered to patients who are not at a high risk of bleeding and who are not having angiography within the next 24 hours.
  • If angiography is likely within 24 hours or a patients creatinine is > 265 µmol/l, unfractionated heparin should be given.
22
Q

What should be given to patients who have intermediate or higher risk of adverse cardiovascular events and scheduled for angiography?

A

Intravenous glycoprotein IIb/IIIa receptor antagonists

  • Eptifibatide
  • Tirofiban
23
Q

When should coronary angiography be done in patients with NSTEMI?

A

Within 96 hours of first admission to hospital for patients with a predicted 6 month mortality above 3%

24
Q

What should be given to patients who have had a TIA to prevent further occlusive events?

A

1st line: Clopidogrel

2nd line: Aspirin & Dipyridamole

Both Lifelong

25
Q

What should be given to patients who have had an Ischaemic Stroke to prevent further occlusive events?

A

1st line: Clopidogrel

2nd line: Aspirin & Dipyridamole

Both Lifelong

26
Q

What should be given to patient who have had a diagnosis of peripheral arterial disease?

A

1st line: Clopidogrel

2nd line: Aspirin

Both Lifelong

27
Q

What should be given to patient who have had PCI?

A

Aspirin (lifelong) & prasurgrel or ticagrelor (12 months)

If aspirin contraindicated, clopidogrel (lifelong)

28
Q

What should be given to patients with Acute Coronary Syndrome?

A

1st line: Aspirin (lifelong) & ticagrelor (12 months)

If aspirin contraindicated, clopidogrel (lifelong)

Year 3: Medicine Block CARDIORESPIRATORY year 5 (28 decks)

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