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Year One - Cardiovascular System > Angina > Flashcards

Angina Flashcards

1
Q

What is angina?

A

It is a condition in which narrowing of the coronary arteries results in reduced blood flow to the myocardium

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2
Q

What are the two classifications of angina?

A

Stable

Unstable

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3
Q

What is stable angina?

A

This is when clinical features are relieved by rest or GTN

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4
Q

What is unstable angina?

A

This is when clinical features are stimulated at rest

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5
Q

What is unstable angina a classification of?

A

Acute coronary syndrome

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6
Q

What is the main clinical feature of angina?

A

Chest pain

This pain may radiate to the jaw or arms

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7
Q

What three investigations are used to diagnose angina?

A

Bloods

CT angiography

ECG scan

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8
Q

What six blood tests are used to diagnose angina?

A

FBC

U&Es

LFTs

Lipid profile

TFTs

HbA1C & Glucose

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9
Q

What is the gold standard investigation used to diagnose angina?

A

CT coronary angiography

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10
Q

What is a CT angiography?

A

A CT coronary angiograph involves inserting a catheter into the patient’s brachial or femoral artery and feeding that up to the coronary arteries under x-ray guidance

There is then contrast injected into the coronary arteries and CT images are taken in time with the heartbeat

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11
Q

In what four ways do we manage stable angina?

A

RAMP

Refer to cardiology

Advise them about the diagnosis, management and when to call an ambulance

Medication

Procedural/Surgical intervention

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12
Q

What do we administer to provide immediate symptomatic relief of angina?

A

GNT spray (sublingual)

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13
Q

What is the function of GNT spray?

A

It causes vasodilation of the coronary arteries

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14
Q

What two medications are administered to provide long term symptomatic relief?

A

Betablocker

AND/OR

Calcium Channel Blocker

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15
Q

What is the first line long term pharmacological management option?

A

Betablocker

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16
Q

Name a beta-blocker used to manage angina. What dose is prescribed?

A

Bisoprolol

5mg once daily

17
Q

What two calcium channel blockers are used to manage angina - when prescribed as monotherapy?

A

Verapamil

Diltiazem

18
Q

What should we do if monotherapy with either a beta blocker or calcium channel blocker is insufficient in controlling angina symptoms?

A

We increase to the maximum dose

THEN

We administer in combination (beta blocker and calcium channel blocker)

19
Q

What calcium channel blocker should be administered to manage angina - when prescribed in combination with a beta-blocker? Which is contraindicated? Why?

A

Long-acting dihydropyridine calcium-channel blocker (amlodipine, nifedipine)

Verapamil - There is a risk of complete heart block, bradycardia and asystole

20
Q

What four drugs are administered if a patient is on monotherapy and cannot tolerate the addition of a calcium channel blocker or a beta-blocker?

A

Long acting nitrate

Ivabradine

Nicorandil

Ranolazine

21
Q

What two long acting nitrates are used to manage angina?

A

Isosorbide

Mononitrate

22
Q

What complication is associated with long acting nitrates? How do we reduce this risk?

A

Tolerance

We advise an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours

23
Q

What is the mechanism of action of nicorandil?

A

It is a potassium channel activator drug, allowing entry of potassium into cardiac myocytes

This results in relaxation of vascular smooth muscle and dilatation of the systemic venous circulation

24
Q

What is the mechanism of action of ivabradine?

A

It is a potassium channel inhibitor drug, which selectively acts on the sinoatrial node

This slows down the diastolic depolarisation of the sinoatrial node – reducing heart rate and therefore myocardial oxygen demand

25
Q

What is the mechanism of action of ranolazine?

A

It is a sodium channel inhibitor drug, which leads to a reduction in intracellular calcium levels

This reduces the tension in the heart muscle, lowering its oxygen demand

26
Q

What four drugs are administered to angina patients to prevent CVD?

A

4As

Aspirin

Atorvastatin

ACEI

Already on a beta-blocker

27
Q

What dose of aspirin is administered to control angina?

A

75mg once daily

28
Q

What dose of atorvastatin is administered to control angina?

A

80mg once daily

29
Q

What two surgical procedures are used to manage angina?

A

Percutaneous coronary intervention (PCI) with coronary angioplasty

Coronary artery bypass graft (CABG)

30
Q

What is PCI with coronary angioplasty?

A

It involves dilating a blood vessel with a balloon and/or inserting a stent

31
Q

Who is offered a PCI with coronary angiography?

A

Those with proximal or extensive disease on CT angiography

32
Q

What is CABG?

A

It involves opening the chest along the sternum, taking a graft vein from the patients leg and sewing it onto the affected coronary artery to bypass the stenosis

33
Q

What vein is often used as a graft in CABG?

A

Great saphenous vein

34
Q

What scar is often left after CABG?

A

Midline sternotomy scar

35
Q

Who is offered CABG?

A

Those with severe stenosis

36
Q

What anticoagulant is administered during CABG?

A

Heparin

37
Q

How do we reverse the effects of heparin?

A

Protamine sulphate

38
Q

What procedure has a higher complication rate and slower recovery time - PCI or CABG?

A

CABG

Year One - Cardiovascular System (20 decks)

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