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Emodules Y3 > Angina > Flashcards

Angina Flashcards

1
Q

What is the basic pathology of angina?

A 
Fatty deposits (plaque) build up in the coronary arteries over time.
The plaque obstructs blood flow and may cause myocardial ischaemia.
This is felt as chest pain.
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2
Q

In the presence of atheromatous lesions, what can coronary arteries do?

A

Constrict or dilate.

This can give rise to varying patterns of angina.

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3
Q

What percentage of patients with coronary thrombus have angina pectoris before an MI?

A

20%

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4
Q

What is the order in which atherosclerosis occurs?

A

Endothelial damage
Lipoprotein oxidation
Leukocyte recruitment
Foam cell formation

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5
Q

What is the definiton of angina pectoris?

A

Chest discomfort due to mycoardial ischaemia, typically associated with coronary artery disease.

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6
Q

Apart from MI, what are some other causes of angina pectoris?

A

Aortic stenosis
Hypertrophic obstuctive cardiomyopathy

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7
Q

What are the different types of angina?

A

Stable angina

Unstable angina

Variant angina (Prinzmetal’s)

Syndrome X

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8
Q

What is stable angina?

A

Angina occuring over several weeks without major deterioation, although symtpoms may vary considerably over time (e.g. with exertion, stress)

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9
Q

What is unstable angina?

A

Abruptly worsening angina or new angina at low work load

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10
Q

What is variant (Prinzmetal’s) angina?

A

Spontaneous (i.e. no precipitating cause) angina with profound ST elevation on ECG.

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11
Q

What is Syndrome X?

A

Angina with objective evidence of myocardial ischaemia (e.g. ST depression) in the absence of evident coronary atheroscleorsis or epicarial (large vessel) disease.

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12
Q

How do you diagnose Prinzmetal’s angina?

A

Mainly from history

The key is if they have pain before going to bed.

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13
Q

What is decubitus angina?

A

Angina that comes on when the patient lies down in bed. It usually occurs in the presence of SEVERE coronary artery stenosis.

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14
Q

What is the mechanism of decubitus angina?

A

Lie down -> Decreased venous pooling -> Increase in myocardial work

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15
Q

Which waves on an ECG typically indicate a previous MI?

A

Q-waves

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16
Q

What is the blood pressure of someone with aortic stenosis?

A

Low blood pressure

17
Q

When would you stop an exercise test?

A

Rapidly dropping ST segment
Blood pressure drops with exercise
Severe chest pain
Arrythmias

18
Q

What is involved in the cause of death of cardiac myocytes following infarction?

A

Cessation of action of Na/K ATPase pumps
Sodium leaking into myocytes
Lack of oxygen

19
Q

What drugs can you give to treat angina?

A

Beta blockers
Nitrates (GTN)
Calcium channel antagonists
Nicorandil (potassium-channel activator)

20
Q

What is the aim of therapy for angina?

A

To reduce morbidity and mortality
To eliminate angina with minimal adverse effect allowing the patient to return to normal activities

The drugs given for these two aims are different

21
Q

What is the general overview of management for an angina?

A

Education and risk factor management
Anti-platelet therapy (aspirin or clopidogrel)
Anti-anginal drug treatment
Follow-up
Revascularisation therapy (PCI or CABG)

22
Q

Name some beta blockers.

A

Propanolol, atenolol, metoprolol

23
Q

Name some CCBs.

A

Dihydropyridines - nifedipine, amlodipine
Others - diltiazem, verapamil

24
Q

Name some nitrates.

A

GTN
Long acting nitrates (ISMN, ISDN)

25
Q

What is first line treatment for angina?

A

Beta blockers - Atenolol 25mg to start, then adjust to reach HR 55-60 or 75% of HR that provokes ischaemia due to exercise.

26
Q

What are some contraindications for beta blockers?

A

ABSOLUTE:

Severe bradycardia
High-grade AV block
Severe, unstable LVF
Asthma

RELATIVE:

Depression
Peripheral vascular disease

27
Q

Why are dihydropyridines not used as monotherapy?

A

They cause reflex tachycardia.

28
Q

What are some contraindications for CCBs?

A

Decompensated heart failure
Bradycardia, high-grade AV block, sick sinus syndrome

29
Q

What are some side effects of CCBs?

A

Hypotension

Peripheral oedema

Cardiac decompensation

Constipation

Headache

Flushing

Dizziness

30
Q

What is the effect of nitrates?

A

Reduces preload and dilate coronary arteries.

31
Q

When are long acting nitrates used?

A

As an adjunt to or instead of CCBs and beta blockers.

A nitrate free interval (8-12 hours) is required.

32
Q

What are the contraindications for nitrates?

A

Outflow tract obstruction

33
Q

What are some side-effects of nitrates?

A

Headache
Hypotension (can be life-threatening if coad with sildenafil)
Presyncope and syncope

34
Q

What is the effect of nicorandil?

A

K+ channel activator with nitrate component
Veno- and arteriodilator
As effective as the other anti-anginals

35
Q

What are the contraindications of nicorandil?

A

Low cardiac output
Hypovolaemia

36
Q

What are the side effects of nicorandil?

A

Headaches

Flushing

Emodules Y3 (8 decks)

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