Angina pectoris

Question 1

Angina, what is it, what is the cause

Answer 1

• Angina is chest pain

- C: due to a reduced blood flow to the heart -> causing ischemia the to heart muscles -> causing chest pain

Question 2

State the different types of angina

Answer 2

• Stable angina
• Unstable angina
• Prinzmetal angina

Question 3

Stable angina: characteristics

Answer 3

• doesn’t experience pain during rest

- experiences pain during exercise, stress, and goes back to normal once the exertion/stress is taken away

Question 4

Stable angina: Causes

Answer 4

• Atherosclerosis or coronary arteries (most common cause), blocking more than 70% of the arteries
• anything causing a thickened myocardium:
  . Hypertrophic cardiomegaly
  .pumping against high pressures (aortic stenosis, HTN)

Question 5

Stable angina: type of ischemia and ECG findings

Answer 5

• subendocardial ischemia

- ECG: ST-depression (NSTEMI)

Question 6

Stable angina: symptoms

Answer 6

• chest pain that lasts less than 20 mins, pain goes away once exertion/stress is taken away
• chest pain radiating to the left arm, jaw, shoulder, back
• dyspnea
• diaphoresis

Question 7

Stable angina: Treatment

Answer 7

• nitroglycerin (vasodilator), aspirin (clopidogrel)
• beta blocker, ACE-1, Ca+ channel blockers
• Statins (<1.8mM)
• diet

Question 8

Unstable angina: characteristics

Answer 8

• chest pain present during exercise/stress, and rest

- is an emergency -> has a high risk of developing into a myocardial infarct (heart attack)

Question 9

Unstable angina: causes

Answer 9

• rupture of atherosclerotic plaque with thrombus formation

Question 10

Unstable angina: type of ischemia and ECG findings

Answer 10

• subendocardial ischemia

- ECG: ST-depression (NSTEMI)

Question 11

Unstable angina: treatment

Answer 11

• nitroglycerin, however, may not be completely relieved by nitroglycerin, which helps to differentiate it from stable angina

Question 12

Difference between unstable angina and myocardial infarct

Answer 12

• unstable angina -> heart tissue is alive, but ischemic

- MI -> heart tissue has already begun necrosis

Question 13

Prinzmetal angina (vasospastic): causes

Answer 13

• Ischemia from the coronary arteries due to vasospasm -> prevents O2 delivery -> causes ischemia
• just like unstable angina, occurs anytime, even at rest

Question 14

Prinzmetal angina: type of ischemia, ECG

Answer 14

• transmural ischemia

- ECG: ST elevation (STEMI)

Question 15

Prinzmetal angina: treatment

Answer 15

• nitroglycerin

- Ca2+ channel blockers

Question 16

Major risk factors of Angina pectoris

Answer 16

• smoking
• DM
• increased cholesterol level
• HTN
• Obesity
• family history
• age
• gender

Question 17

Stable angina: diagnosis

Answer 17

• LAB test
• ECG
• Echo, scintigraphy

Question 18

Stable angina: revascularization techniques used

Answer 18

• PTCA: Percutaneous Transluminal Coronary Angioplasty

- CABG: Coronary Artery Bypass Grafting

Question 19

Prinzmetal angina: RF

Answer 19

• smokers

- middle aged woman

Question 20

Prinzmetal angina: complications

Answer 20

• can cause malignant arrhythmia

- needs urgent coronarography

Question 21

When patient presents with chest pain: what to do

Answer 21

• Make sure the pain is of cardiac orginin, use PQRST pain assessment:

P: Position/ Provoking factors.
Where is the pain, what makes it better/worse, does the pain change when repositioning. AMI chest pain won’t change with repositioning, if it does, other origin. Common that women don’t experience chest pain with AMI.

Q: Quality
Describe the pain, and what kind of pain is it. AMI presents with classic sub-sternal chest pain.

R: Radiation
Is the pain radiating. Most of the time does radiate, left arm, left side of the jaw and back.

S: Severity/Symptoms
Can you rate the pain out of 10. What are the other symptoms. Other symptoms: nausea, vomiting, diaphoresis, dizziness, hypotension, bradycardia, scare.

T: Time
For how long, and is the pain intermittent (comes and goes) or continuous.

• Pain of cardiac nature: then
  Increase O2 to the heart, and reduce O2 demand.

.O2 therapy: provide supplemental O2 in case of hypoxic patient (SpO2 less than 93%) only.

.Coronary vasodilators: Prescribe nitrate, unless patient has hypotension.

.Anti-platelet aggregator: Aspirin
To reduce the risk of thrombus formation.

.Relive pain: Give morphin

• What else to do ?
  ECG, be near a defibrillator, perform a full blood examination.