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CR 2 > Angina > Flashcards

Angina Flashcards

1
Q

2 overall/ umbrella cause of angina

A

low myocardial oxygen supply

increased myocardial oxygen demand

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2
Q

What can cause decreased myocardial oxygen supply?

A

Coronary artery disease

Severe anaemia

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3
Q

What can caused increased myocardial oxygen demand

A

Left ventricular hypetrophy
Right ventricular hypetrophy
Rapid tachyarrhythmias

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4
Q

4 causes of left ventricular hypetrophy?

A

hypertension
aortic stenosis
aortic regurgitation
hypetrophic cardiomyopathy

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5
Q

2 causes of right ventricular hypetrophy?

A

pulmonary hypertension

pulmonary stenosis

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6
Q

5 reasons that angina would need to be referred to a specialist?

A

1) new onset angina
2) exclusion of angina in high risk individuals
3) worsening in patient with previously stable symptoms
4) new or recurrent angina in patient w history of MI/ coronary revascularisation
5) to do w job eg pilot

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7
Q

First step of diagnosing angina

A

HISTORY

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8
Q

What 5 aspects of angina pain need to be established

A 
character
location
radiation
duration 
provocation
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9
Q

What is the main challenge that comes alongside diagnosing angina

A

Determining whether or not the patient w chest pain has flow limiting coronary obstructions

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10
Q

NICE guidelines: 3 aspects of clinical assesment needed for typical angina

A

central chest discomfort lasting 5-15 minutes
provoked by exertion/ emotion
relieved by rest/ nitrates

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11
Q

What is atypical angina

A

Only 2 of NICE characteristics are met

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12
Q

What diagnostic testing is suggested for all patients with typical or atypical angina

A

> 64 slide CT coronary angiography

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13
Q

What drugs can be used to increased oxygen delivery by increasing coronary flow?

A

Nitrates
Calcium channel blockers
Nicorandil
Revasc

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14
Q

What drugs can be used to reduced oxygen demand by reducing heart rate

A

Beta blockers

Ivabridine

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15
Q

What drugs reduced oxygen demand by reducing left ventricular tension

A 
Beta blockers
Nitrates
Nicrorandil
Calcium blockers
Ranolazine
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16
Q

What drugs can be used to reduce oxygen demand by reducing contractility?

A

Beta blockers

Calcium channel blockers

17
Q

What drug can be used to reduce oxygen demand by modifying energy metabolism?

A

Trimetazidine

18
Q

What drug is used/ recommended for secondary prevention of angina in all patient?

A

Aspirin

Statins

19
Q

When should ACE inhibitors be recommended in the secondary prevention of angina

A

If there are other indications such as hypertension or diabetes mellulitis

20
Q

When should a P2Y-12 receptor antagonist be used

A

All patients after percutaneous coronary intervention or if intolerant of aspirin

21
Q

What are the options if drugs do not help with continuing angina?

A

Cardiac catheterisation
PCI if feasable
Coronary bypass surgery

22
Q

What considerations need to be made in chosing a revasc procedure

A
  • Coronary anatomy
  • Patient choice
  • Procedural risk
  • Symptomatic benefit
  • Repeat revasc
  • Prognostic benefit
23
Q

When is a CABG better than PCI?

A

Diabetes
Age> 65
Complex 3VD or LMS disease

24
Q

Diagnostic features of ECG for angina?

A

Exercise ECG

Planar or down sloping ST depression

25
Q

Prognostic features of ECG for angina

A 
Poor exercise tolerance
Early ST depression
Severe ST depression
Exertional arrythmias
Extertional hypotenstion
26
Q

When should a ct coronary angiography be recommended

A

Clinical assesment indicates typical or atypical

Clinical assessment indicates non-anginal chest pain but 12 lead resting ECG indicates ST-T changes or Q waves

27
Q

When should non invasive functional imaging be offered for angina

A

CT coronary angiography has shown CAD of uncertain functional significance or is non diagnostic

CR 2 (33 decks)

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