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Medicine Phase 2a CVS > Angina Pectoris > Flashcards

Angina Pectoris Flashcards

1
Q

What is it

A

Sub-sternal discomfort that is precipitated by exercise but relieved by rest or GTN spray

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2
Q

Causes

A

Atherosclerosis (slowly progressive disease and is the underlying cause of ischaemic heart disease when it occurs in coronary arteries)
Rarely anaemia and tachyarrhythmia

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3
Q

Precipitants of Angina

A

Exercise
Cold weather
Heavy meals

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4
Q

Types

A

Stable angina
Unstable angina
Decubitus angina
Prinzmetal angina

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5
Q

Describe stable angina

A

Precipitated by exercise but relieved by rest

ST DEPRESSION

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6
Q

Describe unstable angina

A

Pain at rest, worsening symptoms

ST DEPRESSION

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7
Q

Describe Decubitus angina

A

Triggered by lying flat

ST DEPRESSION

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8
Q

Describe Prinzmetal angina

A

Due to coronary artery spasm

ST ELEVATION

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9
Q

Pathophysiology of atherosclerosis

A

Fatty streak formation
Fibrolipid plaque formation
Complicated atheroma

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10
Q

Describe fatty streak formation

A

Lipids are deposited in the initimal layer of the artery
Coupled with vascular injury, this causes inflammation, increased permeability and white cell recruitment
Macrophages phagocytose the lipid and become foam cells. These form fatty streak.

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11
Q

Describe Fibrolipid plaque formation

A

Lipid within the intimal layer stimulates the formation of fibrocollagenous tissue
This eventually causes thinning of the muscular media

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12
Q

Describe complicated atheroma formation

A

Occurs when the plaque is extensive and prone to rupture
The plaque may be calcified due to lipid acquisition of calcium
Rupture activates clot formation and thrombosis
If the coronary artery is partially occluded then the result is myocardial necrosis and MI

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13
Q

Investigations

A

ECG:
ECG for signs of ST depression or ST elevation (Exercise is no longer recommended by NICE guidelines)
CT scan; Coronary Calcium score (measured on CT); Coronary angiography
Go for Thallium scan

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14
Q

Conservative treatment

A

Modify risk factors e.g. control cholestrol, control diabetes, smoking cessation advice, weight loss, increase exercise and control hypertension

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15
Q

Surgical treatment

A

Percutaneous transluminal coronary angioplasty
OR
Coronary artery bypass graft (CABG)

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16
Q

Medical treatment

A

Nitrates e.g. Glyceryl Trinitrate spray (first line treat
ABC:
Aspirin
Beta-blockers
Ca2+ antagonists (especially if beta-blokcers contraindicated)
K+ channel activator e.g. Nicorandil

17
Q

When are beta blockers contra indicated

A

Asthma

COPD

18
Q

Side effects of GTN spray

A

Headache

Hypotension

19
Q

What is GTN spray

A

Venous dilator

Decreased preload

20
Q

CABG - which artery do they use (does not atherosclerosis)

A

LRMA

dont ned to know

Medicine Phase 2a CVS (17 decks)

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