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
