Angina Flashcards
What is unstable angina?
Unstable angina is a type of acute coronary syndrome that is defined as one or more of the following in patients whose cardiac biomarker levels do not meet criteria for acute myocardial infarction (MI):
Rest angina that is prolonged (usually > 20 minutes)
Unstable angina is clinically unstable and often a prelude to myocardial infarction or arrhythmias or, less commonly, to sudden death.
Define angina:
acute chest pain due to reversible coronary ischaemia
give 6 modifiable risk factors for angina?
- Smoking
- Hypertension
- Uncontrolled diabetes
- Hyperlipidaemia
- Sedentary lifestyle
- Obesity
Give the 3 key clinical features of stable angina:
1) constricting/ heavy discomfort to the chest, jaw, neck, shoulders or arms
2) brought on by exertion
3) symptoms are relieved by 5 min rest or GTN
What does GTN stand for?
glyceryl trinitrate
What is typical angina?
angina with all 3 clinical features
What is atypical angina?
Angina with just 2 key features
What is stable angina?
Occurs with exercise or emotional stress and is relieved by rest or nitroglycerin
What is unstable angina?
occurs at rest with acute onset (a type of acute coronary syndrome)
What is Prinzmetal’s angina?
angina at rest due to coronary artery spasm
How does Prinzmetal’s angina present on ECG?
ST elevation
What is microvascular angina?
exercise-induced angina with unobstructed coronary vessels
What is refractory angina?
a serious coronary disease where revascularisation is not possible and angina pain and symptoms cannot be controlled
What is refractory angina?
a serious coronary disease where revascularisation is not possible and angina pain and symptoms cannot be controlled by medical therapy (Chronic, doesn’t respond to treatment)
Give 5 lab tests that may be ordered to investigate suspected angina:
1) FBC
2) TFT
3) HbA1C
4) eGFR
5) troponin
Why would we want to order a TFT and HbA1C to investigate a suspected angina?
hyperthyroidism and hyperglycaemia can cause cardiomegaly and thus an oxygen demand supply balance
Why would we want to order troponin to investigate a suspected angina?
to rule out an MI
Name 4 scans/ non-lab tests that may be used to investigate a suspected angina:
1) ECG
2) echocardiogram (to assess left ventricular ejection fraction and regional wall abnormalities
3) CXR (to check for HF)
4) CT coronary angiography
Give the 3 stages of angina management:
1) lifestyle modification and short acting nitrates
2) beta blockers and/ or calcium channel blockers
3) revascularisation
What suffix do beta blockers have?
-olol
Name 3 common calcium channel blockers:
- diltiazem
- Amlodipine
- verapamil
Give two examples of long acting nitrates:
- ivabradine
- nicrorandil
Give the two main types of coronary revascularisation surgeries:
1) percutaneous coronary intervention (dilating vessels with balloons or stents)
2) coronary artery bypass crafting (arteries and veins are attached to native coronary arteries distal to areas of stenosis)
What receptors do beta blockers act on?
beta adrenoreceptors
How do beta blockers treat angina?
they inhibit beta adrenoreceptors which decreases heart rate and blood pressure, reducing myocardial oxygen consumption
How does ivabradine reduce heart rate?
it inhibits the pacemaker
How does nicorandil treat angiNA?
it activates ADP sensitive K+ channels and has nitrate properties, causing vasodilation
How does ranolazine treat angina?
it inhibits Na+ channels in cardiac cells, reducing heart rate and metabolic demand
Give 4 event reducing drugs for angina:
1) aspirin
2) clopidogrel
3) ACEi
4) statins
How does aspirin work as an antiplatelet?
it inhibits COX-1 and thromboxane
How does clopidogrel work as an antiplatelet?
it antagonises P2Y12
What is the name of the syndrome characterised by unpredictable angina with normal coronary vessels with ST segment depression on ECG?
Cardiac syndrome X
How does cardiac syndrome X present on an ECG?
ST segment depression
