angina Flashcards
when does it occur
when there is a mismatch between blood supply and metabolic demand
ECG changes
- ST-T changes
symptoms
- chest pain (heavy, tight)
- central pain
- pain can radiate to jaw/arms
what does adenosine do
stimulate nerve endings and produce pain
who gets it
risk
- increase with age
- hypertension
- hyperlipidaemia
- diabetes
- obesity
- smoking
diagnosis
largely clinical
when does pain occur
usually during exercise
when does unstable angina pain occur
at rest
what can be found on examination
- S4
- anaemia
- thyrotoxicosis
- hyperlipidaemia
investigations
- FBC
- troponin (unstable)
- ECG
- echo
- CXR
what is first line treatment
to change their lifestyle
management algorithm
- lifestyle + nitrates
- beta blocker or calcium
- ivabradine/nicorandil/ranolazine
- revascularisation
- PCI or CABG
side effect of isosorbide mononitrate
- headache
- flushing
what does bisoprolol do
- inhibit beta-adrenoreceptor
- reduces heart rate and BP
- reduces myocardial oxygen consumption
cautions for use of beta blockers
- COPD
- acute heart failure
side effects of beta blockers
- fatigue
- peripheral vasoconstriction
- sexual dysfunction
- bronchospasm
side effect of verapamil
constipation
side effect of amlodipine
- ankle oedema
- reflex tachycardia
how does ivabradine work
- inhibits pacemaker current (funny current)
side effects of ivabradine
- bradycardia
- sick sinus syndrome
how does ranolazine work
inhibits late sodium channels into cardiac cells
how is ranolazine metabolised
by cytochrome P450
ranolazine SE
- constipation
- dizziness
- lengthened QT
mechanism of aspirin
reversible inhibition of COX1 and thromboxane
when should clopidogrel be used
aspirin intolerance
when is atorvastatin used
to reduce LDL cholesterol
what are first line drugs
- beta blocker
then - calcium channel (amlodipine or verapamil)
what are second line drugs
- nicorandil
- ivabradine
- long acting nitrates
- ranolazine
what does nicorandil stimulate
cyclic guanosine monophosphate production producing vasodilatation
when patient is diagnosed what is first thing given
- GTN
- aspirin/statin/ACE inhibitor
what is percutaneous coronary intervention
process of dilating a coronary artery stenosis by introducing an inflatable balloon and metallic stent
how is PCI administered
via the femoral, radial or brachial artery
what is best for administering PCI
radial artery
what are SE of PCI
- bleeding
- haematoma
- dissection
- psuedoaneurysm
how long should antiplatelet therapy be given after PCI
6-12 months
what is coronary artery bypass graft
arteries or veins are anastomosed to the ascending aorta distal to the area of stenosis
whats better PCI or CABG
PCI
