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Chest pain and shortness of breath > Cardiology - Angina > Flashcards

Cardiology - Angina Flashcards

1
Q

What is angina?

A

Heart pain due to reduced blood flow though the coronary arteries

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2
Q

Is angina pain limited to just the chest?

A

No, can radiate to the arm, jaw and neck, during physical or emotional exertion

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3
Q

What are the top two main causes of angina?

A

Myocardial ischaemia and coronary artery disease

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4
Q

What is stable angina?

A

Pain that occurs with physical or emotional exertion and relieved with rest. lasts under 10 minutes

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5
Q

What is unstable angina?

A

Sudden onset of angina during rest

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6
Q

What is coronary artery disease?

A

atherosclerotic plaques within the coronary vessels

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7
Q

What is microvascular angina?

A

.problems with the smallest arteries of the heart

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8
Q

What is coronary artery spasm / prinzmetal angina?

A

a form of unstable angina caused by spasms in the arteries that supply blood to the heart during rest

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9
Q

What is chronic artery disease?

A

occlusion of the coronary arteries resulting in a demand-supply mismatch of oxygen

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10
Q

What are the two categories of chronic artery disease (CAD)?

A

Acute coronary syndrome (ACS)

Chronic coronary syndrome (CCS)

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11
Q

What is chronic coronary syndrome?

A

Patients with Chronic artery disorder, but without Acute coronary syndrome

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12
Q

What can atherosclerosis lead to?

A

Angina and ACS

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13
Q

What are the 3 stages of atherosclerosis development?

A

endothelial dysfunction, plaque formation, plaque rupture

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14
Q

What are the 3 classic features of angina?

A
  • constricting chest pain, typically radiating to the arm/neck/jaw
  • caused by physical exertion
  • Relieved by rest or GTN within 5 minutes
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15
Q

Based on the 3 classic features of angina, what are the three types angina can be differentiated into?

A

Typical - all 3 of the classic features shown
Atypical - 2 of the classic features shown
Non-anginal - 1 or less of the classic features shown

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16
Q

What could palpitations mean in a patient with angina?

A

Angina may be caused by tachyarrhythmias, which increase oxygen supply/demand mismatch, by reducing coronary vessels fillling time

17
Q

What is syncope?

A

A temporary loss of consciousness, due to lack of blood flow

18
Q

What could syncope mean with angina?

A

Cause of angina may be a dangerous valvular or cardiac muscle disease, particularly if occurring during exertion

19
Q

What chest pain related features, could be implications of ACS?

A

Chest pain lasts over 10 minutes
Chest pain not relived by two doses of GTN
Worsening of angina

20
Q

What is stage 1 angina?

A

angina with strenuous activity

21
Q

What is stage 2 angina?

A

angina with moderate activity

22
Q

What is stage 3 angina?

A

angina with mild exertion

23
Q

What is stage 4 angina?

A

angina at rest

24
Q

What is the 5 stage diagnostic work up for angina?

A 
Exclude possibility of ACS
Determine typicality of angina symptoms
basic investigations
determine probability of CAD
offer appropriate testing and therapy
25
Q

What 4 basic investigations can be done for patients

A

blood tests
resting ECG
Echocardiography
chest x-ray

26
Q

What should be checked in bloods when determining if a patient has CAD?

A

FBC, U&Es, Lipid profile, blood glucose, HbA1c

27
Q

What should be checked on the resting ECG when determining if a patient has CAD?

A

pathological q waves
conduction abnormalities
ST-T wave changes

28
Q

What should be checked on the x-ray when determining if a patient has CAD?

A

atypical symptoms

features of heart failure or suspicion of pulmonary disease.

29
Q

What should be checked on Echocardiography when determining if a patient has CAD?

A 
assess LV function
valvular pathology 
motion abnormalities (sign of ischaemic disease/coronary heart disease)
30
Q

What is ischaemia?

A

decrease in blood leading to a decrease in oxygen and nutrients to the affected area

31
Q

What should all patients with angina be offered?

A

A short-acting PRN (e.g. sublingual GTN)

32
Q

What is a GTN?

A

a nitrate used for vascular smooth muscle relaxation, which improves coronary blood flow

33
Q

What can patients with angina be offered as a first line treatment?

A

a beta blocker or calcium channel blocker

34
Q

What type of calcium channel blocker is given during angina treatment and why?

A

a dihydropyridine calcium channel blocker, as non-dihydropyridine calcium channel blockers are contraindicated with beta-blockers

Chest pain and shortness of breath (40 decks)

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