Angina Flashcards
what is another name for angina?
stable coronary artery disease
define stable coronary artery disease
a chronic / recurrent and acute ischaemic heart disease syndrome
what is a angina (pectoris) commonly associated with?
transient chest discomfort or strangling and choking pain in the chest
what characterises stable coronary artery disease?
- reversible or transient episodes of mismatch between myocardial oxygen supply/demand
- related to myocardial ischaemia or hypoxia without cell necrosis (tissues can recover)
what is classic angina?
atherosclerotic plaque-related partial obstruction of epicardial coronary arteries
what is variant angina?
transient, focal or diffuse, spasm of normal or mildly-diseased epicardial coronary arteries
what is microvascular angina?
a primary dysfunction of small diameter (<500 µm) intramural coronary arteries
what are the two major subtypes of angina?
- Angina with obstructive CAD (stable/classic angina)
- Angina without obstructive CAD (INOCA/NOCAD)
three features of angina with obstructive CAD
chest pain on exertion
fixed obstructive CAD (atherosclerotic plaque)
ST-segment depression
4 features of variant angina?
Also called Variant/Prinzmetal/Angiospastic/Vasospastic or Microvascular
pain at rest or at night
focal or diffuse spontaneous coronary artery spasm
ST-segment elevation
arrhythmias
4 features of microvascular angina?
-chest pain at rest or exertion (pain persists after resting and poor response to GTN)
-no angiographic evidence of obstructive CAD
-coronary microvascular dysfunction (endothelial dysfunction, abnormal dilator response, coronary microvascular spasm, heightened response to vasoconstrictors and reduced coronary flow reserve)
-positive stress test – ST-segment depression during
exercise
What clinicla features should you look for in angina?
1) Location
2) Radiation
3) Character
4) Duration
5) Triggers
what is usually the duration of angina?
brief, less than 10 minutes
what is the location of anginal pain
retrosternal, near the sternum
what can trigger angina?
physical exertion, emotional stress, heavy meals and exposure to cold
where does pain radiate in angina?
throat, lower jaw, upper arms, back, epigastrium
what is the character of anginal pain
pressure, heaviness, tightness, discomfort, strangling, constricting, burning (fist)
what are the 3 signs and symptoms ( clinical features) of angina?
1) Pain
2) Haemodynamic-breathlessness, dizziness, syncope, due to ischaemia-induced transient LV dysfunction
2) ECG- Depression/ elevation in ST segment
ST depression vs Elevation
Depression - Subendocardial Ischaemia
Elevation - Transmural Ischaemia
NICE diagnostic work up for angina
what is class 1 angina?
- ordinary activity does not cause angina
- angina with strenuous, rapid, or prolonged exertion only
what is class 2 angina?
-slight limitation of ordinary activity,
-angina on walking or climbing stairs rapidly, walking uphill or exertion after meals, or only during the first few hours after waking
class 3 angina?
- marked limitation on ordinary physical activity
- Angina on walking one or two blocks on the level or one flight of stairs at a normal pace under normal conditions
class 4 angina?
‘Inability to carry out any physical activity without
discomfort’, or ‘angina at rest’
The aims of clinical management of stable CAD
-control symptoms (relieve symptoms of acute attacks)
-reduce ischaemic burden (prevent or reduce the freq of anginal ishaemic)
-improve prognosis (by slowing progression of the underlying atherosclerotic coronary pathology)
what approaches are there to treat angina?
primary- to prevent getting it i.e diet exercise
secondary- when you already have it
What does it mean to have a multifaceted approach
Using multiple therapy techniques:
-lifestyle and risk factor modification (aggressive management of modifiable atherosclerotic CAD risk factors)
-pharmacological therapy (for symptomatic control)
-Myocardial revasculation (PCI, CABG)
What are the 4 lifestyle modifications someone with stable angina can make
- diet, smoking cessation, exercise and weight loss
what is the basic principles of drug treatment for angina?
increase myocardial oxygen supply and reduce myocardial oxygen demand or both
Secondary Prevention for someone with stable CAD
-Blood Pressure Control
-ACEI (for diabetic)
-Diabetes Control
-Aspirin 75 mg daily (antiplatelet)
-Statin (hypolipidaemic)
name the 4 drug treatment options of angina
Organic nitrates & nitrites
-Adrenoceptor antagonists (b-blockers)
Calcium channel blockers
Miscellaneous agents- nicorandil, ivabradine, ranolazine
