Angina And Peripheral Vascular Diseases Flashcards
What are the symptoms of stable angina
No pain at rest
Pain with certain level of exertion - can be worse with cold weather/emotions
Pain relieved by rest
What are the signs of stable angina
Often none Occasionally hyperdynamic circulation: Anaemia Hyperthyroidism Hypovolemia
What investigations should be carried out in patients with angina
ECG - resting and during exercise
Angiography
Echocardiography
Radioisotope studies
What is angiography
Using a dye to look at the patency of arteries
What is echocardiography
Using ultrasound to look at function of heart valves and ventricles
What are radioisotope studies used for and why are they useful
Looks at the proportion of blood ejected from the left ventricle CNS
Useful to see how much residual function is present
Why is an ECG during exercise useful
Test ischaemia of the heart in real time
Allows changes to bee seen and stopped at the reversible stage
ST depression increases as ischaemia increases
In what ways can angina be treated
Reduce oxygen demands of the heart
Increase oxygen delivery to the tissues
How can the oxygen demands of the heart be reduced
Reduce afterload (blood pressure) Reduce preload (venous filling pressure) Correct mechanical issues such as failing heart valves or septal defects
How can oxygen delivery to the tissues be increased
Dilate blocked or narrowed vessels - angioplasty
Bypass blocked or narrowed vessels - Coronary Artery Bypass Graftine (CABG)
Describe non-drug therapy in angina
Explanation of illness - patient may require understanding of what triggers their angina and can manage their lifestyle to avoid these situations
Modify risk factors - stop smoking, graded exercise programme, improve diet and control cholesterol
Which drugs can be used to treat angina
Aspirin - reduce MI risk
Treat hypertension - Diuretics, Ca2+ blockers, ACE inhibitors and beta blockers
Emergency treatment - GTN spray
Long term prevention - Isosorbide mononitrate
What surgical therapies can be carried out on patients with angina
CAGB
Angioplasty and Stent
Describe a Coronary Artery Bypass Graft
Veins taken from leg and reversed to prevent occlusion of blood flow by the valves
Internal mammary artery diverted to the coronary artery supply
Only possible if blockage is close to origin of the artery
Describe angioplasty and stunting
Cannula put in femoral artery in leg or radial or brachial in arm then passed through vascular system to the narrowing
Balloon is blown up which squashes the plaque then stent will click into position
When balloon is removed, the stent if left holding open the artery
