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PHASE 2 cardio conditions > angina > Flashcards

angina Flashcards

1
Q

what 3 conditions are classed under ischaemic heart disease (IHD)

A
  1. angina
  2. acute coronary syndrome
  3. myocardial infarction
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2
Q

define angina pectoris

A

Chest pain caused by an insufficient blood supply to the myocardium (ischaemia) and induced by physical exertion or emotional stress.

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3
Q

how to relieve angina

A

It must be relieved with rest or with a dose of sublingual GTN

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4
Q

5 types of angina

A
  1. stable
  2. unstable
  3. decubitus
  4. prinzmetals - vasospastic angina
  5. nocturnal angina
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5
Q

pathophysiology of angina

A

Atherosclerosis leads to narrowing of coronary arteries that results in ischaemia

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6
Q

symptoms of angina (4)

A
  1. Central chest tightness provoked by exertion
  2. Pain may radiate to one or both arms, neck or jaw
  3. Dyspnoea, sweating and nausea
  4. syncope (loss of consciousness)
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7
Q

most common cause of angina

A

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

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8
Q

other causes of angina (6)

A
  1. LV hypertrophy – increased distal resistance
  2. Anaemia – reduced O2 carrying capacity
  3. Hypoxia – reduced availability of O2
  4. Coronary artery thrombosis
  5. Coronary artery spasm
  6. Arteritis
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9
Q

diagnosis & investigations for angina

A
  1. 12 lead ECG
  2. CT angiography
  3. stress ECG (ischaemia inducing exercise stress test)
  4. bloods
  5. CXR – check heart size and pulmonary vessels
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10
Q

what would a 12 lead ECG on angina patient find

A

either normal or ST elevation

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11
Q

what would CT angiography on an angina patient find

A

Shows narrowing of a coronary artery

Once narrowing is shown it is then possible to go in and open with a stent or balloon

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12
Q

what blood tests should you do for an angina patient

A

FBC – anaemia
Cardiac enzymes
Glucose
Lipid profile

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13
Q

5 treatment options for angina

A
  1. lifestyle
  2. treat underlying conditions
  3. medication/pharmaceutical
  4. Percutaneous Coronary Intervention (PCI)
  5. Coronary artery bypass graft (CABG)
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14
Q

which patients should never do an excercise ECG

A

people with known CAD

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15
Q

what is stable angina

A

Induced by effort and relieved by rest

this is the usual one

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16
Q

what is unstable angina

A

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

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17
Q

what is decubitus angina

A

occurs lying down

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18
Q

what is Variant (Prinzmetal’s) angina

A

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.

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19
Q

Nocturnal angina

A

occurs at night and may wake patient from sleep

20
Q

signs of angina

A

Chest pain comes on with exertion and rapidly resolved by rest and/or GTN

Exacerbated by cold weather, anger and excitement

21
Q

differential diagnosis of angina (5)

A
  1. Pericarditis/Myocarditis
  2. Pulmonary Embolism
  3. Chest infection
  4. GORD
  5. Dissection of the aorta
22
Q

lifestyle modifications for angina

A

Weight loss
More exercise
Quit smoking

23
Q

which underlying conditions should be treated for angina

A

hypertension and diabetes mellitus

24
Q

7 pharmaceutical treatment options for angina

A
  1. Glyceryl Trinitrate (GTN) spray – 1st line
  2. beta blockers
  3. Ca2+ channel blockers
  4. anti platelet drugs
  5. statins
  6. ACE inhibitors
  7. ivabradine
25
Q

what does GTN spray do

A

Dilate coronary arteries which reduces preload – nitrate is a venodilator

26
Q

side effect of GTN spray

A

headache

27
Q

3 examples of beta blockers

A

bisoprolol, atenolol, propranolol

28
Q

what do beta blockers do

A

Reduce HR and force of contraction
(negatively chronotropic and inotropic)

29
Q

when are beta blockers contra-indicted and what should you use instead

A

in asthma or in patients with heart block

Use a Calcium channel blocker instead

30
Q

what do calcium channel blockers do

A

Block calcium influx into the cell and utilisation of calcium within the cell

Relax coronary arteries and reduce force of LV contraction

arterodilators

31
Q

example of a calcium channel blocker

A

amlodipine

32
Q

example of antiplatelet drug for angina

A

75mg Aspirin

33
Q

what does aspirin do for angina

A

inhibits platelet aggregation by inhibiting COX

34
Q

what to give if aspirin is contraindicated

A

Clopidogre

35
Q

what do statins do

A

reduce cholesterol

HMG-CoA reductase inhibitor

36
Q

2 examples of statins

A

atorvastatin, simvastatin

37
Q

2 examples of ACE inhibtors

A

Ramipril, lisinopril

38
Q

what do ACE inhibitors do

A

blood pressure control

If severe consider angiotensin receptor blocker e.g. candesartan or losartan

39
Q

what does ivabradin do

A

inhibits pacemaker current in the SAN and therefore reduces heart rate

can also be used if beta blockers are contraindicated

40
Q

what is Percutaneous Coronary Intervention (PCI)

A

Stenting or ballooning the narrow artery

Less invasive, shorter recovery

41
Q

risk associated with PCI

A

Risk of restenosis (re-narrowing) or thrombosis

BUT

Drug-eluting stents reduces risk of restenosis

42
Q

benefit and risk of Coronary artery bypass graft (CABG)

A

good prognosis

longer recovery

43
Q

how long does a stable angina attack last

A

less than 20 minutes

44
Q

what is most commonly affected in stable angina

A

Subendocardium

45
Q
A

PHASE 2 cardio conditions (20 decks)

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