Angina Flashcards
Define angina
Chronic/acute ischaemic heart disease associated with transient chest discomfort/pain due to reduced blood flow to heart
Angina is characterised by reversible/irreversible mismatch between myocardial O2 supply & demand
reversible
List the 3 types of angina
Classic angina
Variant angina
Microvascular angina
Describe classic angina and its effect on myocardial O2
Atherosclerotic plaque partially obstructs coronary arteries, so myocardial O2 demand increases and the supply cannot match it
When does classic angina normally occur
Exercise/stress induced
Describe variant angina and its effect on myocardial O2 supply
Spasm of coronary arteries due to a decrease in myocardial O2 supply
When does variant angina normally occur?
Rest/asleep
Describe microvascular angina
Primary dysfunction of small coronary arteries due to a functional/structural defect resulting in chest pain at rest or on exertion
Name the 2 clinical subtypes of angina
Angina with obstructive CAD
Angina without obstructive CAD
Describe the features of angina with obstructive CAD
- effort induced, chest pain on exertion
- fixed obstructive CAD = atherosclerotic plaque
- ST-segment DEPRESSION
Describe the features of angina without obstructive CAD
- pain at rest/night
- spontaneous coronary artery spasm
- ST-segment ELEVATION
- Arrhythmias
- Variant angina - angiospastic
- microvascular angina - syndrome X
What is the result of a positive stress test for microvascular angina during exercise
ST-segment depression
List the 3 clinical features of angina
haemodynamic
metabolic
electrocardiographic
State why angina causes breathlessness & dizziness
Due to ischaemia-induced transient LV dysfunction
Describe the metabolic effects of angina
Increased myocardial lactate breakdown & net ATP breakdown due to anaerobic metabolism
What does an ECG machine show for a person with angina
ST-segment depression OR elevation
What is the aim on clinical management of angina?
Control symptoms
Prevent/reduce frequency of anginal episodes
Slow progression
Prolong survival
Describe 3 features of the multi-faceted approach to manage angina
- lifestyle & risk factor modification
- pharmacological therapy for symptomatic control
- myocardial revascularisation
State how does pharmacological/anti-viral drug therapy work to treat angina
Improves myocardial O2 supply and reduces demand
Describe the pharmacological action of nitrates & nitrites
Directly acts on blood vessels by reducing vascular r
tension (vasorelaxation) -> systemic vasodilation ( decreases SVR & increases BF)
Describe the cellular mechanism of vasorelaxation
In vivo conversion to NO
Activation of guanalyte cyclase which increases cGMP
Activation of PKG -> vasorelaxation
Describe the mechanisms of the anti anginal effect of nitrates
- peripheral venodilation decreases preload -> decreases MV O2
- peripheral arterial & arteriolar dilation decreases afterload -> de creases MV O2
- coronary vasodilation reverses & prevents spasm
Describe the process of nitrate action to decrease preload
Peripheral venodilation peripheral pooling of blood decreases venous return decreases ventricular volume & intraventricular pressue decreases CO decreases myocardial O2 demand
List adverse effects of the clinical use of nitrate treatment for angina
- flushing
- headaches (throbbing)
- postural hypotension
- reflex tachycardia
- increases myocardial contractility
Describe the recommendations for nitrate therapy
- begin with a small dose & establish dose threshold
- use the smallest amount possible that gives symptomatic relief
- nitrate interval of 8-10hrs (split doses to 8am & 2pm)