Angina Pectoris Flashcards
Identify 5 risk factors for angina pectoris
- Smoking
- Hypertension
- Diabetes
- Obesity
- Hypercholesterolaemia
- Male gender
Identify the three features of angina pectoris
- Pain is heavy and constricting
- Pain is precipitated by physical exertion
- Pain is relieved by rest or GTN within 5 minutes
What is atypical angina?
- Presence of 2 out of 3 of the features of angina pectoris
Identify a finding on ECG in stable angina
- ST depression
What are the criteria for performing 64-slice CT coronary angiography?
- Clinical assessment indicates angina
- EEC demonstrates ST depression
What is the criteria for performing MPS with SPECT?
- CT coronary angiography has shown coronary artery disease
What is the criteria for performing invasive coronary angiography?
- Results of MPS with SPECT are inconclusive.
Identify 5 differential diagnoses of angina pectoris
- Aortic dissection
- Pericarditis
- Pulmonary embolism
- Pneumothorax
- Gastroesophageal reflux disease
- Biliary colic
- Acute cholecystitis
- Costochondritis
When should GTN spray be prescribed in angina pectoris?
- Symptom relief whilst awaiting specialist referral
Identify two possible first-line treatments for angina pectoris
- Beta blocker (atenolol)
- Rate limiting calcium channel blocker (verapamil or diltiazem)
Identify four alternative first-line treatments if both beta-blockers and calcium channel blockers are contraindicated
- Isosorbide mononitrate
- Ivabradine
- Nicorandil
- Ranolazine
What is the second line treatment of angina pectoris?
- Beta blocker or calcium channel blocker.
- Plus 1 alternative
What is the third line treatment of angina pectoris?
- Beta blocker or calcium channel blocker.
- Plus 2 alternatives
Identify 4 drugs for the secondary prevention of cardiovascular disease
- Aspirin
- Rivaroxaban
- Ramipril
- Atorvastatin
Identify 2 conditions for considering revascularisation (CABG or PCI)
- Symptoms are not controlled with medication
- Angiography demonstrated left main stem disease or three-vessel disease
Identify an advantage of CABG over PCI
- Survival advantage in patients with diabetes, 65+ and have three-vessel disease
When is a diagnosis of microvascular angina considered?
- Continuing symptoms despite drug treatment and revascularisation
- Normal coronary arteries
Identify three adverse effects of rate limiting calcium channel blockers
- Constipation
- Bradycardia
- Heart block
- Hot flushes
- Headache
- Ankle oedema
Identify two contra-indications of rate limiting calcium channel blockers
- Heart block
- Unstable angina
- Severe aortic stenosis
Identify three adverse effects of cardioselective beta blockers
- Fatigue
- Cold extremities
- Sleep disturbance
- Nightmare
- Impotence in males
- Headache
- GI disturbances
Identify two contraindications of cardioselective beta blockers
- Asthma
- Heart block
Identify an important interaction of cardioselective beta blockers
- Rate limiting calcium channel blocker
- Can cause heart failure and asystole
Identify three side effects of nitrates
- Flushing
- Headaches
- Hypotension
- Tolerance
- Methaemoglobinaemia in overdose
Identify an importance interaction of nitrates
- Phosphodiesterase 5 inhibitors
Identify two contraindications of nitrates
- Severe aortic stenosis
- Hypotension
Identify three adverse effects of nicorandil
- Flushing
- Dizziness
- Headache
- Nausea
- Vomiting
- Hypotension
- Ulceration of genitals, eyes and skin
Identify three contraindications of nicorandil
- Poor left ventricular function
- Hypotension
- Pulmonary oedema
Why are rate limiting calcium channel blockers preferred over dihydropyridine calcium channel blockers for the treatment of angina?
- Rate limiting calcium channel blockers lower heart rate and decrease myocardial contractility
- Dihydropyridines can cause tachycardia which can worsen symptoms of angina
Identify three lifestyle changes for patients with angina pectoris
- Avoid provoking factors such as stress
- Smoking cessation
- Cardioprotective diet
- Increase in physical activity
- Limitation of alcohol consumption
