Angina Flashcards
Investigations for angina
Exercise testing
V/Q scan
CT angiography
Angiography
Pros of exercise testing for angina
Cheap
Reproducible
Risk stratification
Cons of exercise testing for angina
Poor diagnostic accuracy
Sub maximal test
Pros. Of V/Q scan for angina
Non invasive
Pharma logical stress in less mobile patients
More precise than ETT
Risk stratification
Cons of V/Q scan for angina
Radiation
False positives & negatives
Pros of CT angiography for angina
Non invasive
Anatomical data and risk stratification
Cons of CT angiography for angina
Radiation
Less precise than angiography
Cost
How is angiography done?
Sheath inserted into artery
Catheter advance from wrist or groin
X Ray contrast agent onjected
Video fluoroscopy recorded images
Pros of angiography in angina
“Gold standard”
Anatomical data and risk stratification
Flow-on angioplasty
Cons of angiography for angina
Radiation Contrast (renal dysfunction, rash, nausea)
First line treatment of stable angina
GTN spray
Second line treatment of angina
Beta blocker or calcium channel blocker
Angina treatment if patient cannot tolerate beta blockers and calcium channel blockers
Long acting nitrate Or Ivabradine Or Nicorandil Or Ranolazine
When do you consider adding a third anti-anginal
If symptoms not adequately controlled on 2
AND
Patient is waiting for revascularisation or revascularisation is not an option
When do you offer CABG to stable angina patients?
Symptoms not controlled by optimal medical treatment
AND
Revascularisation is considered inappropriate
AND
PCI is not appropriate
When do you offer PCI to stable angina patients?
Symptoms not controlled by optimal medical treatment
AND
Revascularisation is considered inappropriate
AND
CABG is not appropriate
What does GTN spray do?
Dilates coronary afteries and increases blood flow to the heart
Clinical features of angina
Passing, squeezing tightness on chest Radiates to back, neck, jaw, teeth On exertion, stress, cold wind, after meals Relieved by rest Patient has risk factors
Factors which make patients suitable for revascularisation
Multi vessel disease (diffuse or local)
Left main disease
Diabetes
Co-morbidities
Indications for angiography
Severe symptoms
High risk
Factors which make patients suitable for revascularisation
Multi vessel disease (diffuse or local)
Left main disease
Diabetes
Co-morbidities
Indications for angiography
Severe symptoms
High risk
What kind of drug is nicorandil?
Potassium channel activator
