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Cardiovascular Conditions (JBR) > Angina Pectoris > Flashcards

Angina Pectoris Flashcards

1
Q

What causes angina?

A

Myocardial ischaemia, mostly caused by atheroma

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2
Q

What is stable angina?

A

Induced by exercise/exertion - relieved by rest

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3
Q

What is unstable angina?

A

Increased frequency or severity; occurs on minimal exertion - associated with increased MI risk

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4
Q

What is angina decubitus?

A

Precipitated by lying flat

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5
Q

What is variant (aka Prinzmetal’s) angina?

A

Due to coronary artery spasm

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6
Q

What are sign/symptoms of angina?

A

Central chest tightness/heaviness brough on by exertion and received by rest
May radiate to neck, jaw, arms and teeth
Can also be precipitated by emotion, cold, weather and heavy meals
Associated with dyspnoea, nausea, sweatiness, faintness

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7
Q

Which investigations would be done?

A

ECG - usually normal but may show ST depression; flat or inverted T waves
Thallium scan
Cardiac CT
Coronary angiography

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8
Q

How do you treat stable angina?

A

Beta-blocker
CCB
GTN
Potassium channel opener (Nicorandil)

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9
Q

What is the mechanism of a GTN?

A

Relax all types of smooth muscle via their metabolism to nitric oxide

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10
Q

Small doses of GTN lead to?

A

venorelaxation

Decreased preload & SV

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11
Q

Higher doses of GTN cause?

A

Decreased MAP

Decreased afterload

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12
Q

What is the effect of a GTN?

A

Coronary blood flow is redirected to ischaemic zone (collateral arterioles dilated)
Decrease myocardial O2 requirement
Decrease after load
Increase ischaemic perfusion

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13
Q

How is a GTN administered?

A

Sublingual

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14
Q

Why are GTNs not given orally?

A

First pass metbaolism

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15
Q

What are side effects of GTN?

A

Repeated admin associated tolerance
Postural hypotension
headaches

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16
Q

How can repeated administration tolerance be avoided?

A

Build in nitrate low periods

E.g. Take it in the morning and afternoon but not at night

17
Q

What is the mechanism of a potassium channel opener?

A

Open vascular smooth muscle ATP-modulated K channels by antagonising intracellular ATP
Hyperpolarisation
Switch off L-type Ca channels

18
Q

Nicorandil predominantly acts on?

A

Arteriolar smooth muscle

19
Q

What are side effects of nicorandil?

A 
Nausea
Vomiting
rectal bleeding 
Cutaneous vasodilation - flushing 
Increase HR (@high doses) 
Dizziness
Headache (esp. on initiation, usually transitory) 
Weakness
20
Q

How do you treat angina decubitus (unstable angina)? (medication)

A 
Aspirin
IV heparin (or IV GTN)
21
Q

What is heparin?

A

Naturally occurring sulphated glycosaminoglycan of variable molecular size

22
Q

How does antithrombin III neutralise all serine protease factor in the coagulation cascade?

A

By binding to their active site

23
Q

What is heparin’s mechanism of action?

A

Binds to ATIII increasing its affinity for serine protease factors to increase their activation

24
Q

How is heparin administered?

A

IV/SC

25
Q

What is required to determine the dose of heparin?

A

In vitro clotting test

26
Q

What are side effects of heparin?

A

Haemorrhage
Osteoporosis (long-term treatment)
Hypo-aldosteronism
Hypersensitivity reactions

27
Q

What can reverse heparin?

A

Protamine sulfate IV

28
Q

CABG is recommended for angina patient with?

A

Three-vessel or left main coronary artery disease

29
Q

PCI is indicated in?

A

Severe / high risk angina

30
Q

How is Variant (Prinzmetal’s) angina treated?

A

CCB + Long acting nitrate

31
Q

What is an example of a long-acting nitrate?

A

Isosorbide Mononitrate

32
Q

What is isosorbide mononitrate used for?

A

Prophylaxis for angina attack and more sustained effect

not for acute relief

33
Q

The side effects of isosorbide mononitrate are the same as for?

A

GTN

Cardiovascular Conditions (JBR) (20 decks)

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