Angina Flashcards
why does angina arise
due to myocardial ischamia. (imbalance between oxygen delivery and deman)
what is angina described as?
crushing, central retrosternal pain coming on with exertion and usually relieved by rest within few mintues or GTN.
also usually precipitated by cold weather, heavy mealks, emotional stress and excitement.
what is stable angina
induced by effort and relieved by stress
what is decubitus angina
when lying down
what is nocturnal angina
at night and usually wakes the patient
what is variant or Prinzmetal’s angina?
coronary vessel spasm which can occur even in normal coronary arteries with no provocation and occurs at rest.
treat with calcium channel antagoniss with or without nitrates.
betablockers should be avoided as they increase vasopasms (ST elevation may occur)
and asprin aggravates ischaemic attack.
what is unstable (cresecendo) angina?
increasing severity, recent onset, unpredicatble, occurst at rest
whats cardiac syndrome X?
symptoms of angina which present with a positive stress test but normal coronoary arteries on agniogram due to functional abnormalities with coronary microscirculation, wherin abnormal vasodialtor responce due to stress.
what are the other symptoms of angina?
dizzienss dysopnea nausea faintness sweating
what is the gold standard test for angina and when is it done?
Coronary artery angiogram (diagnostic)
done in pateints with positive stress test or negative stress test but with symptoms.
what are the other investigations that you can do and what do they show?
- ECG = at rest shows ST depression and during an attack shows T wave flattenign or inversion. must be repeated to show dynamic changes.
- Stress ECG
- myocardial perfusion imaging (inject dobutamien and thalium scan)
- stress echo (if there is angina or ST depression within 6 minutes reffer for angiogram)
what are risk factors for angina? (9)
1) age ( 55 or more in men and 65 or more in women)
2) smoking
3) DM
4) dyslipidaemia
5) hypertension
6) family history of premature CVD (M < 55 and F< 65)
7) obesity (BMI of 30 kg/m2 or more)
8) physical inactivity
9) kidney disease (microalbuminea or GFR < 60 mL/min)
DDx for angina? and Beck’s triad? (10)
1) stable angina
2) ACS
3) pericarditis (sharp pain relieved by sitting forward)
4) myocarditis
5) Printzmental’s angina
6) aortic dissection - radiates in the back (must be excluded as thromoblyis is fatal)
7) cardiomyopathy
8) cardiac tamponade - Beck’s triad = muffled heart sounds, hypotension, dilated neck veins
9) Arrthymias
10) valvular disease
what are the GI DDxs for angina? (4)
1) reflux / GORD
2) peptic ulcer
3) Oesophagela rupture
4) Cholecystitis
what are the pulmonary DDxs for angina? (5)
1) PE
2) Pneumothorax
3) Pneumonia
4) Pleurisy
5) Lung cancer
