Angina Flashcards
What is Ischaemic Heart Disease?
Spectrum of heart disease resulting from atherosclerosis in the coronary arteries.
What is Angina?
A clinical syndrome that occurs when there is imbalance between supply and demand of Oxygen/nutrients to the myocardium, resulting in myocardial ischaemia.
Aetiology of Angina (2).
- Atherosclerosis.
- Aortic Stenosis.
Pathophysiology of Stable Angina.
Atherosclerosis - gradual enlargement of a stable plaque leading to luminal stenosis (Poiseuille’s Law).
Clinical Presentation of Angina (3).
- Constricting Pain in Chest/Neck/Arm/Jaw.
- Triggered by Exertion.
- Alleviated by Rest/GTN within Minutes.
What is Atypical Angina?
2 out of the 3 features.
Gold-Standard Investigation of Stable Angina.
Gold-Standard : CT Coronary Angiography.
Management of Stable Angina - General (4).
RAMP :
1. R - Refer to Cardiology.
2. A - Advise about Diagnosis, Management and Safety Netting.
3. M - Medical Management.
4. P - Procedural/Surgical Management.
Aims of Medical Management (3).
- Immediate Symptomatic Relief.
- Long-Term Symptomatic Relief.
- Secondary Prevention of Cardiovascular Disease.
Immediate Medical Management.
GTN - Glyceryl Trinitrate Sublingual Spray causes vasodilation. Repeat after 5 minutes and call ambulance if pain persists after 2 GTN sprays.
Long-Term Symptomatic Medical Management (3).
- B-Blocker or Rate-Limiting CCB.
- Combination of 1*.
- Other : Isosorbide Mononitrate (Long-Acting Nitrate); Ivabradine; Nicorandil; Ranolazine.
Combination Therapy in Long-Term Symptomatic Management (2).
- Use a long-acting DHP CCB e.g. Modified-Release Nifedipine if using with a B-Blocker.
- Don’t prescribe concurrent B-blocker with Verapamil - risk of complete heart block.
How should Isosorbide Mononitrate be taken?
Asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimise the development of nitrate tolerance.
Secondary Prevention of Cardiovascular Disease (3).
- Aspirin 75mg Once Daily.
- Atorvastatin 80mg Once Daily.
- ACE Inhibitor.
Procedural/Surgical Interventions in Stable Angina (2).
- PCI with Coronary Angioplasty.
- CABG - Coronary Artery Bypass Graft.
When is CABG offered?
Severe stenosis.
What does CABG involve?
Midline sternotomy and harvesting from great saphenous vein.
Adverse Effect of Nicorandil.
Ulceration anywhere in the GI tract.
