[angina pectoris] Flashcards
myocardial ischaemia due to atheroma
aortic stenosis small vessel disease anaemia tachyarrythmias hypertrophic cardiomyopathy
Cardiac syndrome X
brought on by exercise
relieved by rest
arm (both)
neck
jaw
teeth
dyspnoea
faintness
sweatiness
nausea
at rest
increasing severity angina (crescendo)
angina associated with lying flat
angina due to coronary artery spasm
Prinzmetal’s angina
anyone! usually those with no risk factors for atherosclerosis
at rest
elevated ST segment
which resolves when the pain subsides
aspirin (aggravate the attack) beta blockers (increase vasospasm)
calcium channel blockers
long-acting nitrates
MRI
myocardial perfusion scintigraphy
stress echo
echocardiogram done after supervised exercise
known CAD (coronary artery disease) typical pain
none assume stable angina (ECG already performed)
exercise testing
functional imaging
age
typical/atypical/non-anginal pain
low/high risk
hyperlipidaemia
diabetes
smoking
35
45
55
65
reconsider CAD as a Dx
CT scan to determine coronary artery calcification score
Calcification of coronary arteries is a sign of atherosclerotic disease and can be quantified using
multislice computed tomography
functional imaging
(MRI
myocardial perfusion scintigraphy
stress echo)
angiography
or
functional imaging
assume CAD present
greater than 6.7 mmol/L
> 70 years
either typical OR atypical pain
> 70
High risk
typical symptoms
61-90%
ECG
Diabetes Hyperlipidaemia thyrotoxicosis anaemia temporal arteritis (GCA)
thyrotoxicosis
depressed ST segment
flat/inverted T waves
> 4mmol/L
unstable
Smoking weight exercise (wt. loss only beneficial if exercise maintained) hypertension diabetes cholesterol
b-blockers calcium antagonists - long acting nitrates K+ channel activator Aspirin
75-150mg/24hrs
reduced mortality by 34%
lifestyle advice
aspirin
aspirin
clopidogrel
nitrates
GTN spray/sub-lingual tablets
b-blockers
metoprolol: 50-200 mg orally
asthma (absolute!) COPD LVF bradycardia coronary artery spasm (variant/prinzmetal)
if there is a CI to beta blockers
amlodipine 10mg/24hrs
diltiazem
lifestyle + aspirin b-blocker nitrates calcium antagonists K+ channel activator
nicorandil 10mg/24hours
Dx uncertainty new angina of acute onset unresponsive to drugs recurrent angina (past MI/CABG) unstable angina
PTCA
percutaneous transluminal coronary angioplasty
PTCA
CABG (increased risk of stroke)
isosorbide mononitrate 20-40mg PO
prevent nitrate tolerance
angina = imbalance between myocardial O2 demand and supply for any reason inc. thrombus
ACS = thrombus formation —> occlusion