Angina Pectoris Flashcards

1
Q

What are 3 features of angina?

A

1 Constricting/heavy discomfort to the chest, jaw, neck, shoulders or arms

2 Symptoms brought on by exertion

3 Symptoms relieved within 5 min by rest or glyceryl trinitrate

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2
Q

what is typical vs atypical angina?

A

Typical angina has all features of angina
Atypical has only 2 features of angina
If only 0-1 = non anginal chest pain

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3
Q

What can precipitate angina?

A
Cold weather
Emotion
Heave meals
Exertion
Severe anaemia
Cardiomyopathy
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4
Q

What are associated symptoms with angina?

A

Dyspnoea
Nausea
Sweatiness
Faintenss

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5
Q

What kind of pain would make you think angina is less likely?

A

Continuous pain
Pleuritic pain
Associated with swallowing
Associated with palpations, dizziness or tingling

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6
Q

What are causes of angina?

A
Atheroma
Anaemia
Coronary artery spasp
Aortic stenosis
Tachyarythmias
Cardiomyopathy
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7
Q

Describe the process of atherosclerosis

A

Endothelial dysfunction
High levels of lipid in the blood leads to deposition of lipid in the tunica intimacy of arteries forming a fatty streak.
Leucocytes and smooth muscle cells migrate into the arterial wall
Foam cells form
Extracellular matrix is degraded
The atherosclerotic plaque grows
It can be disrupted exposing the blood to thrombogenic material leading to complete occlusion of a vessel

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8
Q

What are the types of angina?

A

Stable angine: induced by effort, relieved by rest

Unstable angina: Angina of increasing frequency or severity, occurs on minimal exertion or at rest, associated with increased risk of MI

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9
Q

Describe stable vs unstable angina

A

Stable: induced by exercise, relived by rest or GTN
Unstable - angina that changes or worsens:
1. occurs at rest (or with minimal exertion)
2. Severe and of new onset
3. Occurs with a crescendo pattern

Stable angina - developing atheroma is protected with fibrous cap.
In unstable angina this cap may rupture allowing blood clots to precipitate and further decrease the area of the coronary vessel lumen.

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10
Q

What is decubitus angina?

A

Precipitated by lying flat

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11
Q

What tests would you do for chest pain?

A

Bedside
ECG - usually normal but may show ST depression, flat or inverted T waves
Exercise ECG - for ischameic changes

Bloods
FBC, U&E, TFT, lipids, HbA1c

Imaging:
Angiography - cardiac CT with contrast or trans catheter
Stress echo
CXR
Cardiac MRI
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12
Q

What advice would you give to someone with angina?

A
Stop smoking
Exercise
Low fat diet
Lose weight
Optimise blood pressure 
Control diabetes well
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13
Q

Give a management plan for angina

A

Lifestyle advice
75mg aspirin daily if not CI
Hyperlipidaemia - statin
ACE inhibitor

PRN glyceryl trinitrate

Antianginal medication
1: Beta blocker / CCB

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14
Q

What is used for symptoms relief in angina? How does this work? SE? What should you advise about this?

A

GTN spray/sublingual
Increases amount of NO in blood which relaxes SMC in vessels causes vasodilation

SE: Hypotension, headache

If pain is still present, repeat dose, wait 5min after second dose - call ambulance if still painful

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15
Q

What is the pharmacological management for angina?

A

1 beta blocker e.g. atenolol/bisprolol
2 Calcium antagonist e.g.. amlodipine
3 Long-acting nitrates: isosobide mononitrate
4 Ivabrandine - reduces HR, must be in sins rhythm
Nicorandil - potassium channel activator

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16
Q

What interventions can be considered when medical management is inadequate? Compare the two

A

Revasularisation
Percutaneous coronary intervention - balloon is inflated in the stenosed vessel, opening the lumen. Stent is inserted to reduce risk fo re-stenosis. Dual anti platelet therapy (aspirin and clopidogrel) recommended for 12 months after stent insertion to reduce the risk of stent thrombosis.

CABG - saphenous vain or radiating artery used to create bypass graft for stenosed vessel

CABG less likely to need repeat revascularisation compared with PCI and better outcomes for multi vessel disease but
Recovery is slower and patient is left with two large wounds

17
Q

What is PCI and CABG? What is recommended after a PCI?

A

Revasularisation
Percutaneous coronary intervention - balloon is inflated in the stenosed vessel, opening the lumen. Stent is inserted to reduce risk fo re-stenosis. Dual anti platelet therapy (aspirin and clopidogrel) recommended for 12 months after stent insertion to reduce the risk of stent thrombosis.

CABG - saphenous vain or radiating artery used to create bypass graft for stenosed vessel

18
Q

What are 3 important investigations for ischaemic heart disease

A

Exercise ECG - monitor for ischaemic changes

Angiography - cardiac CT with contrast or transcatheter

Functional imaging - stress echo, myocardial perfusion scintigraphy

19
Q

How would you investigate/treat typical angina in a patient with previous IHD?

A

Treat as stable angina

Use non invasive testing for further confirmation - exercise ECG

20
Q

How would you investigate /treat typical and atypical angina?

A

CT angiography
Funcitonal imaging as 2nd line
Transcatheter as 3rd line

21
Q

What could cause angina in a patient unlikely to have IHD?

A

Severe anaemia

Cardiomyopathy

22
Q

Describe vasospastic angina.

A

Angina due to coronary artery spasm. Pain usually at rest and resolves rapidly with GTN.
ECG during pain shows ST elevation.

Triggers include cocaine, amphetamine, marijuana, low magnesium and iatrogenic

23
Q

What can cause angina recurrence after CABG?

A

Graft failure - blockage of graft or another vessel

Progression of angina to unstable angina