Angina Flashcards
What are the two physiological causes of angina?
Decreased myocardial O2 supply or increased demand.
What can cause decreased myocardial O2 supply? (1:4,1)
Coronary artery disease: atherosclerosis, spasms, vasculitic disorders, post radiation therapy.
Severe anaemia.
What can increase myocardial O2 demand?(3)
Left ventricular hypertrophy, right ventricular hypertrophy, rapid tachyarrythmias.
What can cause left ventricular hypertrophy? (4)
Hypertension, aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy
What can cause right ventricular hypertrophy? (2)
Pulmonary hypotension, pulmonary stenosis
How is angina diagnosed? (5)
Mainly by history. Character, location, radiation, duration, provocation of pain
What would you expect on an exercise ECG in a patient diagnosed with angina?
Planar or down sloping ST depression.
What signs would there be on an exercise ECG of a patient that has a prognosis of angina? (4)
Poor exercise tolerance, early ST depression or severe ST depression, exertional arrhythmias, exertional hypotension
What further investigations could be done?
Functional imaging or anatomical imaging
What are the goals of treatment of angina? (3)
Increase oxygen delivery, reduce oxygen demand, reducing secondary complications.
What would you use to increase oxygen delivery?
Nitrates, nicorandil, revasc, calcium antagonists
How would you reduce oxygen demand?(3 factors)
Decrease heart rate with beta blockers, decrease contractility and left ventricular wall tension with beta blockers or calcium antagonists
What would you prescribe all patients with angina to reduce secondary complications?
Aspirin and a statin
What else might you give to patients with angina?
ACE inhibitors in cases of comorbidities like diabetes
Clopidogrel if intolerant to aspirin
What are the two major surgeries that could be performed to treat angina?
PCI- percutaneous coronary intervention- stent
CABG- coronary artery bypass graft
