Angina Flashcards
describe the mechanism that causes angina
it is myocardial ischaemia that is ‘demand led’
i.e. occurs when the heart is working harder
what symptoms are seen with angina
chest pain, dyspnoea, sweating
describe the chest pain felt in angina
central chest tightness, may radiate to arm or jaws, usually brought on by exertion and relieved by rest/GTN spray
what investigations are done for angina
ECG, exercise ECG, angiography
what is the first step of stable angina treatment
lifestyle modification, secondary prevention(e.g. statin) and GTN spray
describe what GTN spray is and its role in angina treatment
glyceryl trinitrate(GTN), nitrate that is a short-acting vasodilator and relieves angina symptoms
what is the second step of stable angina treatment
beta-blocker OR calcium channel blocker(CCB)
what can be given to treat angina if beta-blockers and CCB are not tolerated or are contraindicated
long acting nitrate(e.g. isosorbide mononitrate), ivabradine, nicorandil, ranolazine
what treatment is given to angina patients if beta-blockers or CCB have been given and patient is still symptomatic (step 3)
switch from beta-blocker to CCB, or vice versa
OR give beta-blocker + dihydropyridine
what is given as step 4, the final pharmacological treatment of stable angina
2 anti-anginals
what are some drugs that are anti-anginals (6)
beta-blockers, CCBs, nitrates, ivabradine, nicorandil, ranolazine
what treatment is considered if a patient is still symptomatic after being on 2 anti-anginal drugs
revascularisation, either PCI or CABG
give an example of an antiplatelet drug that may be used in angina treatment
aspirin
when may an ACE or ARB be used in angina treatment, and give an example of both
used to treat co-existing cause/disease
ACE = lisinopril
ARB = losartan
give an example of a CCB and a beta blocker
CCB = verapamil(non-dihydropyridine) or amlodipine(dihydropyridine)
beta blocker = bisoprolol
