Angina Flashcards
pathophysiology of angina
narrowing of coronary arteries (typically due to atherosclerosis) reduces blood flow to the myocardium
during times of high demand, e.g. exercise, there is insufficient blood supply to match demands – resulting in symptoms of angina
classical symptoms of angina
central chest pain that may radiate to jaw / arms
difference between
- stable angina
- unstable angina
stable - induced on exertion + relieved by rest / GTN spray
unstable - comes on at rest (considered an acute coronary syndrome)
gold standard investigation
CT Coronary angiography
what are the 3 targets of angina management
immediate symptom relief
long term symptom relief
secondary prevention of cardiovascular disease
what is given for immediate relief of angina
GTN spray – causes vasodilation to improve symptoms
- take GTN spray, repeat after 5 mins, if pain still present – call an ambulance
1st line long term anti-anginal
beta blocker (bisoprolol) or calcium channel blocker (verapamil/diltiazem)
- both can be used in combination if one insufficient
- avoid beta blocker + verapamil due to risk of heart block
- use nifedipine in combo with beta blocker instead
2nd line anti-anginal agents
isosorbide mononitrate- long acting nitrate
nicorandil - opens potassium channels
ivabradine - blocks HCN channels
ranolazine - blocks sodium channels
if a combination of 2 anti-anginal agents is insufficient, what further treatment options can be considered
PCI - relieves symptoms
CABG - relieves symptoms + reduces mortality
side effects of GTN
headache
flushing
light headedness
drugs given for secondary prevention of cardiovascular disease
aspirin 75mg
statin - atorvastatin 80mg
ACEi
what is decubitus angina
angina variant induced by lying down
what is prinzmetal angina
angina variant that occurs at rest, due to coronary spasm
ST elevation during attack that resolves with rest
