Angina Flashcards
What is it?
Usual cause?
Who does it usually affect?
What sex is it more common in?
Chest pain due to ischaemia
Athersclerosis
Over 65’s
Men
S+S
What is the main precipitant?
Describe the pain - SOCRATES
What 2 things provide relief?
Exertion as precipitant
Constricting discomfort of anterior chest which may radiate to neck, shoulders, jaw or arms
GTN or rest provides relief within 5 minutes
Investigations:
Bloods:
- what is done to rule out anaemia
- what is done to check for co-morbidity, CKD and ACEi baseline
- what is done CVD risk factors -2
FBC
U&E
Lipids and glucose
Investigations:
Diagnostic imaging - 1st line
What is a stress echo and myocardial perfusion scintigraphy or MR perfusion used for?
What is used if above is not diagnostic?
CTCA - CT coronary angiogram
Functional imaging using stress agents
Invasive angiography
A CT angiogram is a less invasive test than a standard angiogram. A standard angiogram involves threading a thin tube called a catheter through an artery in your arm or leg up to the area being studied. But with a CT angiogram, no tubes are put in your body.
Management:
(1) Anti-anginals:
1ST LINE:
- What cardiac drug will reduce the rate, therefore reducing the demand for oxygen?
- What cardiac drug will cause vasodilation?
2nd line:
- How does Ivabradine help?
- What is an example of a sodium channel blocker - Ra
What should be considered for permanent control if not controlled by 2 drugs?
Beta-Blockers and/or calcium channel blockers
Reduces HR with minimal impact on BP
Ranolazine
Revascularisation - PCI and CABG - coronary artery bypass graft
Management:
(2) SYMPTOMATIC RELIEF - Short-acting nitrate
- 2 ways to administer?
- When should it be used? - 2
- What to do if the pain lasts more than 5 minutes? - 2
What are 3 side effects of vasodilation? - think back to cardiac drugs
GTN spray or sublingual tablets
Before planned activity or when symptomatic
Call ambulance and take 2nd dose
The same sort of opening up of blood vessels can occur in the head and the brain, and this is what can lead to a headache.
Flushing - dilation of superficial vessels
Light-headedness/dizziness - hypotension
Management:
(3) CVD prevention:
- What 3 meds can be used to reduce risk?
Lifestyle:
- What could be changed?
- What type of diet should they adopt?
Aspirin (clopidogrel 2nd line)
Statins
ACEi
Lifestyle changes - exercise, mediterranean diet, stop smoking and alcohol
4 types of angina and features:
Stable angina - what 2 features does this have?
Unstable - how do you know stable angina has progressed to unstable angina?
What is decubitus angina?
What is variant angina?
Stable - induced by effort and relieved by rest
Unstable - increased frequency and severity, occurs with minimal exertion/at rest
Decubitus - comes on by lying flat
Variant - caused by coronary artery spasm
