Case 1: Chest Pain Flashcards
3 features of angina
1) heavy discomfort to the chest, jaw, neck, shoulders or arms
2) symptoms brought on by exertion
3) symptoms relieved within 5 mins by rest or GTN
What is typical and atypical angina
Typical is all 3.
Atypical is 2 of
1) heavy discomfort to the chest, jaw, neck, shoulders or arms
2) symptoms brought on by exertion
3) symptoms relieved within 5 mins by rest or GTN
Precipitants of angina
Cold
Emotion
Exercise
Heavy meals
What is stable angina
Induced by effort.
Relieved by rest.
Good prognosis
What is unstable angina
Increasing frequency or severity
Occurs on minimal exertion or at rest
Increased risk of MI
Other symptoms associated with angina
Dyspnoea
Nausea
Sweatiness
Faintness
Causes of anaemia
Atheroma
Rarely: anaemia, coronary artery spasm, valvular heart disease
Risk factors for angina
Smoking Age HTN Diabetes raised cholesterol Previous mi FH
Investigations for angina
ECG (often normal but may show signs of previous MI - ST depression, flat/inverted T waves)
Bloods (FBC, U&E, TFT, lipids, HbA1c)
Echo
CXR
Angiography
PRN symptom relief of angina
GTN spray or sublingual tabs
Counselling for use of GTN spray
Take when in pain Wait 5 mins Take again if pain still present Wait 5 mins If pain still present call 999
Side effects of GTN
Headache
Low blood pressure (dizziness etc)
Flushing
How do nitrates (GTN) work?
Release NO
Vasodilation
Treatment for stable angina
Beta blocker (atenolol, bisoprolol) or Ca channel blocker (amlodipine) Long acting nitrates Ivabradine Ranolazine Nicorandil (k channel activator)
Secondary prevention of cardiovascular disease when have angina
Aspirin Statins ACEi (if diabetic) Lifestyle advice Control HTN and diabetes
Why does hyperthyroidism / thryotoxicosis exacerbate angina?
Hyperthyroidism causes tachycardia and HTN
Side effects of aspirin
Gastric ulcers
Dyspepsia
Nausea / vomiting
Side effects of beta blockers
Bronchospasm
Reduce hypoglycaemia awareness
Fatigue
Cardiac depression /bradycardia
Side effects of calcium channel blockers
Flushing
Headaches
Peripheral oedema
Constipation
Side effects of K channel activators
Headaches Nausea / vomiting Flushing Dizziness Abdominal pain Ulcers
ACS protocol
O2 if sats <94% Morphine Nitrates LMWH 2 anitplatelets (e.g. aspirin & clopidogrel/ticagrelor)
Tx for STEMI
If symptoms started >12 hours ago give fondaparinux
If symptoms started <12 hours ago give reperfusion therapy. If can get to PCI within 120mins then do PCI. If cannot get to PCI within 120mins then thrombolyse
What cardioprotective drugs do you prescribe after ACS?
Aspirin for life Ticagrelor / clopidogrel for 12 months Beta blocker ACEi High dose statin
Pericarditis: bacterial / viral / fungal?
Bacterial - staphylococcus aureus
