angina Flashcards
what 3 conditions are classed under ischaemic heart disease (IHD)
- angina
- acute coronary syndrome
- myocardial infarction
define angina pectoris
Chest pain caused by an insufficient blood supply to the myocardium (ischaemia) and induced by physical exertion or emotional stress.
how to relieve angina
It must be relieved with rest or with a dose of sublingual GTN
5 types of angina
- stable
- unstable
- decubitus
- prinzmetals - vasospastic angina
- nocturnal angina
pathophysiology of angina
Atherosclerosis leads to narrowing of coronary arteries that results in ischaemia
symptoms of angina (4)
- Central chest tightness provoked by exertion
- Pain may radiate to one or both arms, neck or jaw
- Dyspnoea, sweating and nausea
- syncope (loss of consciousness)
most common cause of angina
Coronary artery atheroma - atherosclerotic plaques consisting of accumulations of lipids, macrophages and smooth muscle cells in the intima
Results in reduced blood flow or a fixed obstruction to coronary blood flow
other causes of angina (6)
- LV hypertrophy – increased distal resistance
- Anaemia – reduced O2 carrying capacity
- Hypoxia – reduced availability of O2
- Coronary artery thrombosis
- Coronary artery spasm
- Arteritis
diagnosis & investigations for angina
- 12 lead ECG
- CT angiography
- stress ECG (ischaemia inducing exercise stress test)
- bloods
- CXR – check heart size and pulmonary vessels
what would a 12 lead ECG on angina patient find
either normal or ST elevation
what would CT angiography on an angina patient find
Shows narrowing of a coronary artery
Once narrowing is shown it is then possible to go in and open with a stent or balloon
what blood tests should you do for an angina patient
FBC – anaemia
Cardiac enzymes
Glucose
Lipid profile
5 treatment options for angina
- lifestyle
- treat underlying conditions
- medication/pharmaceutical
- Percutaneous Coronary Intervention (PCI)
- Coronary artery bypass graft (CABG)
which patients should never do an excercise ECG
people with known CAD
what is stable angina
Induced by effort and relieved by rest
this is the usual one
what is unstable angina
increases in severity, occurs at rest or is of recent onset (less than 1 month)
Can be due to thrombus formation on top of thorombotic plaque Can also happen at rest
what is decubitus angina
occurs lying down
what is Variant (Prinzmetal’s) angina
caused by coronary artery spasm and results in angina that occurs without provocation, usually at rest
Likely involves vasoconstriction factors like platelet thromboxame A2. All layers are affected - Transmural ischaemia.
Nocturnal angina
occurs at night and may wake patient from sleep
signs of angina
Chest pain comes on with exertion and rapidly resolved by rest and/or GTN
Exacerbated by cold weather, anger and excitement
differential diagnosis of angina (5)
- Pericarditis/Myocarditis
- Pulmonary Embolism
- Chest infection
- GORD
- Dissection of the aorta
lifestyle modifications for angina
Weight loss
More exercise
Quit smoking
which underlying conditions should be treated for angina
hypertension and diabetes mellitus
7 pharmaceutical treatment options for angina
- Glyceryl Trinitrate (GTN) spray – 1st line
- beta blockers
- Ca2+ channel blockers
- anti platelet drugs
- statins
- ACE inhibitors
- ivabradine
what does GTN spray do
Dilate coronary arteries which reduces preload – nitrate is a venodilator
side effect of GTN spray
headache
3 examples of beta blockers
bisoprolol, atenolol, propranolol
what do beta blockers do
Reduce HR and force of contraction
(negatively chronotropic and inotropic)
when are beta blockers contra-indicted and what should you use instead
in asthma or in patients with heart block
Use a Calcium channel blocker instead
what do calcium channel blockers do
Block calcium influx into the cell and utilisation of calcium within the cell
Relax coronary arteries and reduce force of LV contraction
arterodilators
example of a calcium channel blocker
amlodipine
example of antiplatelet drug for angina
75mg Aspirin
what does aspirin do for angina
inhibits platelet aggregation by inhibiting COX
what to give if aspirin is contraindicated
Clopidogre
what do statins do
reduce cholesterol
HMG-CoA reductase inhibitor
2 examples of statins
atorvastatin, simvastatin
2 examples of ACE inhibtors
Ramipril, lisinopril
what do ACE inhibitors do
blood pressure control
If severe consider angiotensin receptor blocker e.g. candesartan or losartan
what does ivabradin do
inhibits pacemaker current in the SAN and therefore reduces heart rate
can also be used if beta blockers are contraindicated
what is Percutaneous Coronary Intervention (PCI)
Stenting or ballooning the narrow artery
Less invasive, shorter recovery
risk associated with PCI
Risk of restenosis (re-narrowing) or thrombosis
BUT
Drug-eluting stents reduces risk of restenosis
benefit and risk of Coronary artery bypass graft (CABG)
good prognosis
longer recovery
how long does a stable angina attack last
less than 20 minutes
what is most commonly affected in stable angina
Subendocardium
