CCS - HARD Flashcards
location of chest pain
- retrosternal
- L arm - jugular
fist size
tests for IHD
use stress conditions to look for ischemia
- exersize ECG
- MRI
- PET
prognostic treatment
lipid modification:
- statins
- ezetimbe - 2nd line
- PCSK9 inhibitors
antiplatelet:
- aspirin
- clopidogrel
revascularisation:
- angioplasty + stents
- bypass surgery
lifestyle modification - LDL target
<1.4
50%+ reduction
symptomatic treatment
CCB
BB
nitrates
potassium channel blockers
ivabradine - slows SAN reducing HR
ranolazine - inhibits Na - less contraction
ANOCA main gender effected and possible main cause
women
diseases that effect the microvessels
stable angina medication
- short acting nitrate
- 75mg daily of aspirin
- ACE inhibitors
- statin
how to assess chest pain?
OPQRST
- onset
- position (site)
- quality (nature/character)
- relationship (with exersize)
- radiation
- relieveing or aggrevating factors
- severity
- timing
- treatment
4 types of angina
- stable - normal 3 point definition
- unstable - pain at rest, not relieved by inactivity or GTN spray - no ECG changes
- prinzmetals - due to coronary vasospasm - cocaine users - ST elevation
- decubitus - induced when lysing flat + usually a complication of cardiac failure
diagnosis of stable angina occlusion
70-80%
reasons for imperfect blood supply
- atherosclerosis
- thrombosis
- thromboemboli
- artery spasm
- collateral blood vessels
- blood pressure / cardiac output / heart rate
- arteritis
side effect of aspirin
gastric ulceration
side effects of BB
- erectile dysfunction
- tiredness
- nightmares
- bradycardia
- cold hands and feet
symptoms of IHD
central crushing chest pain radiating to jaw/neck, worsens over time
nausea
sweating
fatigue
dyspnoea
impending sense of doom palpitations
symptoms not associated with angina
no fluid retention
palpitations
syncope / pre-syncope
stable angina - if CCB/BB contradicted
ranolazine
ivabradine
nicorandil
what vessels can CABG use?
- internal mammary artery from chest
- saphenous vein from leg
stable angina - secondary prevention
3As:
- atovastatin 80mg
- aspirin 75mg
- acei
if peristance occurs:
- PCI
- CABG
long term relief stable angina
CCB
BB
if not tolerated:
ivabradine
nicorandil
acts of GTN
vasodilation
talk through all the different medications and when they would be used
- initial medication - symtpom relief:
- BB (bisoprolol)
- if BB not good - switch to CCB (virapamil / diltiazem)
DO NOT COMBINE
if this doesnt work:
- bisoprolol + amlodipine / nifedipine
if this doesnt work:
- bisoprolol + amlodipine / nifedipine + long acting nitrate
if cant use long acting nitrate:
ranozaline
nicorandil
ivabradine is HR>70
- prevent progression
- 75mg aspirin
- 80mg atorvastatin
- ACEi
contraindications:
swap aspirin for clopidogrel
if remains high add ezetimibe then if still doesnt work add PCSK(
when should you inform the DVLA if you have angina
when its bought on by no exersion - pain at rest
1st line diagnostic technique
CT coronary angiography
what should you never prescribe beta-blockers with because of a risk of heart block
verapamil
diltiazem
costrochondritis
- inflammation where your costal margin is
- It can cause sharp chest pain, especially when moving or breathing
- It usually gets better on its own over time.
- usually thought to be a heart atack
- localised to single point
- young fit people
treatment:
- hydration
- algesia
- NSAIDs
when should you not give ivabradine
HR <70
isosorbide mononitrate (ISMN)
nitrate
choice of CCB
rate-limiting eg verapamil, diltiazem
NOT IN ADDITION TO BETA BLOCKERS
if the patient is on 2 antianginals with low BP, what do you add?
long acting nitrate
Nicorandil
Ranolazine
(ivabradine if BP >70)
when administering a CCB + BB what should the CCB be?
Amlodipine or Felodipine
otherwise both negative inotrophic
stable angina classification
Class I: no angina with normal physical activity. Strenuous activity may cause symptoms.
Class II: angina pain causes slight limitation on normal physical activity.
Class III: angina causes marked limitation on normal physical activity.
Class IV: angina occurs with any physical activity and may occur at rest (see unstable angina).
