Angina Flashcards
What investigations should be done in Angina?
ECG BP Cardiac Enzymes (Aand E if troponin is raised) FBC Fasting glucose and lipids ESR TFTs at hospital: CT angiogram to prove angina
What is first/second/third line medication in Angina?
BB (Bisoprolol) or CCB
(if one is ineffective try the other then try both)
Start at low doses and titrate up
What CCBs are used for what in Angina?
Verapimil is ionotrophic and slows heart down
Nifedipine is a vasoldilator and doesnt affect rate
Amlodipine is a vasodilator but long duration and given once daily
When can verapimil NOT be used?
With BBs
In heart failure
What is the 4th line treatment for angina?
Long acting nitrate while waiting for CABG or PCI
What is used in angina prevention?
ACEi
Statin
Antiplatelet = Aspirin 75mg
When should you admit patients with angina?
- Current pain
- Pain in last 12 hours with ECG changes
- Pain 12-72 hours ago merits same day investigation in hospital
- Pain >72 hours ago merits full assessment, ECG and troponin
What are the side effects of CCBs?
Headache
Flushing
Ankle Oedema
Constipation
What are the side effects of BBs?
Bronchospasm
Cold peripheries
What causes angina?
Coronary Artery Disease
Where does pain from angina radiate?
Jaw,
Neck
Arms
What is angina exascerbated by?
Excercise
Cold
Emotion
Heavy meals
What are risk factors for angina?
FH
Smoking
Vascular disease
What is angina pain associated wiht?
Sweating
Palpitations
Nausea
Breathlessness
What are the side effects of GTN spraY?
Flushing
Headache
Light headed
What is the lifestyle advice that must be given to someone with angina?
Occupational hazards addressed Smoking cessation BP control Diet DM treat Alcohol Cardiac rehab Exercise
What is the deal with driving and angina?
Dont need to tell the DVLA
You may continue to drive if you have angina (even if you need medication) unless it happens while resting, driving, or with emotion. You must stop driving until your symptoms are under control if it does.
When are long acting nitrates contraindicated?
Aortic or mitral stenosis
What is the issue with long acting nitrates?
Tolerance develops
Give an example of a long acting nitrate
Isosorbide mononitrate
What is unstable angina?
Pain at rest or on minimal excercise or at night
Can worsen fast
What is needed in unstable angina?
Urgent Cardiology referral
What is Prinzmetals angina?
Coronary artery spasm
What is seen on ECG of Prinzmetals angina?
ST elevation
How do you treat prinzmetals?
GTN, CCB and refer
