Angina Flashcards
What is angina?
Angina describes a condition marked by severe pain in the chest, characteristically radiating to the shoulders, arms and neck - due to inadequate supply to the heart
Where does angina-like pain typically radiate to?
To the shoulders, arms and neck
What is IHD?
Ischaemic heart disease is an inability to adequately perfuse the myocardium, predominantly caused by atherosclerosis of the epicardial coronary arteries.
What features are associated with typical angina?
- Precipitated by physical exertion or emotional stress
- Chest pressure or squeezing lasting several minutes
- Relived by rest of glyceryl trinitrate (GTN) within 5 minutes.
- Constricting discomfort in the front of the chest, in the neck, shoulders, jaw or arms.
For patients with typical angina, the administration of sublingual GTN, will have what effect?
Relief within 5 minutes
What are the triggers for typical angina?
Precipitated by physical exertion or emotional stress.
What additional features are associated with atypical angina?
Presents with two features found in typical angina, in addition to atypical symptoms including gastrointestinal discomfort and/or breathlessness and/or nausea
What factors make stable angina less likely?
Pain that is continuous or prolonged
Pain that is unrelated to activity
Pain that is brought on by breathing
Pain that is associated with dizziness, palpitations, tingling or difficulty swallowing
What are the classifications for stable angina?
The pain or discomfort upon physical exertion to which the demands on the heart have increased
Occurs for a short period of time (<5 minutes)
Relieved by rest of GTN
How is stable angina relieved?
Sublingual GTN
Describe the period in which a stable angina presents?
For a short period of time <5 minutes
What is an unstable angina?
Occurs when individual is resting, persisting longer than stable angina
Rest or medicine does not alleviate the angina,
Progressively worsen over time –> MI
What is a prinzmetal angina?
The pain from variant angina is caused by a spasm in the coronary arteries caused by exposure to cold, smoking or stress
What type of angina is caused due to a vasospasm?
Prinzmetal angina
What investigations are considered in patients presenting with angina?
ECG
Coronary angiography
Exercise tolerance test
Lab tests (Complete blood profile, lipids, renal test, liver function tests, cardiac enzymes)
What cardiac enzyme is typically elevated in a patient with an MI/ released in response to cardiac damage?
Troponin
If troponin levels are normal in patients presenting with angina, what is indicated?
Suggestive that the symptoms and chest pain are attributed to cardiac muscle damage, and more likely that the pain is due to stable angina.
What other cardiac biomarkers are elevated in patients presenting with angina?
Myoglobin
CK-MB
BNP
What is the short-term management for patients presenting with angina?
Short-acting nitrate - Sublingual GTN
Beta-blockers or calcium channel blockers (amlodopine)
A patient with an ST-segment elevation in leads I, AvL and V6, alongside reciprocal changes in leads III and AvF will manifest as what type of STEMI?
Lateral STEMI
Which coronary artery is linked to a lateral STEMI?
Left circumflex
Diagonal D1 artery of the LAD
Which leads have an ST elevation in an anterior STEMI?
V1, V2, V3 and V4
Which coronary artery is associated with an anterior STEMI?
Left coronary artery
Left anterior descending artery (LAD)
What reciprocal changes are evident in an anterior view STEMI?
None
What ST-elevations are -present in a lateral view STEMI?
I, AvL, V5, V6
What reciprocal changes are seen in patients with a lateral STEMI?
Leads III, AvF
Which leads are concerned with ST-elevations in an inferior view STEMI?
II, III, AvF
Which artery is involved with an inferior view STEMI?
Right coronary artery
What reciprocal changes are evident in an inferior view STEMI?
Leads I, and AvL
Which leads have ST-Elevation in a posterior view STEMI?
V7-9
Which coronary artery is associated with a posterior view STEMI?
Right coronary artery
ST elevations in leads V7,. V8 and V9, are associated with which view?
Posterior view
Which leads are linked with a septal view of the heart?
Leads V1 and V2
What immediate drug is prescribed to patients with a STEMI?
Loading dose of 500mg Aspirin (Antiplatelet and add-on anti-ischaemic drug/anticoagulation)
In a patient with a STEMI, what intervention is recommended for re-perfusion therapy?
A PCI
What is the alternative to a PCI?
Thrombolysis or rescue PCI or CABG
What is the long-term management for patients with an STEMI?
Anti-platelet therapy, statin, beta-blocker, ACE inhibitor, cardiac rehabilitation, and lifestyle changes
What is the biggest risk with a STEMI?
Thrombosis and cardiac failure
Angina that is not relieved by rest, is most likely to be what?
Unstable Angina /NSTEMI
What is an NSTEMI?
There is an incomplete thrombus formation. This does not completely obstruct blood and oxygen; however, the partial restriction is significant to the extent that oxygen is depleted rapidly.
• Tissue necrosis occurs in the distal arteries and arterioles as a product of oxygen starvation.
• Small, affected area Insufficient to cause ST-elevation
• Troponin elevation
In terms of thrombus formation, what happens in an NSTEMI?
Incomplete thrombus formation, there is partial obstruction of the coronary arteries
Why is there not ST-elevation in an STEMI?
There is partial occlusion, thus this is insufficient to cause ST-elevation
What is unstable Angina?
The plaque becomes unstable, and the fibrous cap is disrupted, thrombus is formed
There is a sufficient luminal diameter to satisfy the demand during rest
What is the main difference between an NSTEMI and unstable angina?
Troponin is elevated in a NSTEMI?
In a patient with positive troponin NSTEMI, what is the recommended management?
Invasive mangement:
CA, CABG, PCI
What is the recommended management for a patient with a low risk NSTEMI/unstable angina?
Conservative management (Sublingual GTN for symptom relief)
Stress test - if positive considering invasive
