chronic coronary synrome d Flashcards
what is angina
a mismatch of oxygen supply and demand
commonest reason for angina
IHD
predisposing factors for IHD
• Age
• Cigarette smoking
• Family history
• Diabetes mellitus
• Hyperlipidemia
• Hypertension
• Kidney disease
• Obesity
• Physical inactivity
• Stress
exacerbating factors that affect oxygen supply
• Anemia
• Hypoxemia
• Polycythemia
• Hypothermia
• Hypovolaemia
• Hypervolaemia
exacerbating factors that affect oxygen demand
• Hypertension
• Tachyarrhythmia
• Valvular heart disease
• Hyperthyroidism
• Hypertrophic cardiomyopathy
environmental risk factors that make IHD worse
- cold weather
- heavy meals
- emotional stress
when does myocardial ischaemia occur
when there is an imbalance between the hearts oxygen demand and supply, usually from an increase in demand eg exercise accompanied by limitation of supply
3 reasons for limited blood supply
- Impairment of blood flow by proximal arterial stenosis
- Increased distal resistance eg left ventricular hypertrophy
- Reduced oxygen-carrying capacity of blood eg anemia
what is ohms law
V = IR
so
change in P = QR
4 other types of angina
- prinzmetals angina (coronary spasm)
- microvascular angina ( syndrome x)
- crescendo angina
- unstable angina
how to take a history for IHD
• Personal details (demographics, identifiers)
• Presenting complaint
• History of PC + risk factors
• Past medical history
• Drug history, allergies
• Family history
• Social history
• Systematic enquiry
cardiac symptoms
chest pain (tightness/discomfort)
breathlessness
fluid retention
palpitation
syncope or pre can scope
questions to ask to do with angina pain 9 (OPQRST)
Onset
Position (site)
Quality (nature / character)
Relationship (with exertion, posture, meals, breathing and with other symptoms) Radiation
Relieving or aggravating factors
Severity
Timing
Treatment
factors pointing towards ischaemic cardiac pain
• Character
• Location
• Provoking factors
• Relieving factors
• Associated symptoms
• Associated risk factors
what is the differential diagnosis of myocardial ischaemia when presented with chest pain
• Pericarditis/ myocarditis
• Pulmonary embolism/ pleurisy
• Chest infection/ pleurisy
• Dissection of the aorta
• Gastro-oesophageal (reflux, spasm, ulceration)
• Musculo-skeletal
• Psychological
treatment for angina
• Reassure
• Lifestyle
– smoking
– Weight
– Exercise
– diet
• Advice for emergency
• Medication
• Revascularisation
what investigations for angina
routine bloods
lipids
ECG
impact of beta blockers on heart
decrease heart rate
decrease LV contractility
decrease cardiac output
decrease oxygen demand
side effects of beta blockers
tiredness, nightmares
bradycardia
erectile dysfunction
cold hands and feet
what does aspirin do
cyclo-oxygenase inhibitor
decrease prostaglandin synthesis
decrease platelet aggregation, antipyretic, anti inflammatory , anaglgesic
side effect of aspirin
gastric ulceration
gp level treatment of angina
aspirin
GTN
beta blocker
statin
hospital level treatment of angina
ACE inhibitor
long acting nitrate
revascularisation
Ca ++ channel blocker
potassium channel opener
ivabradien
pros of PCI revascularisation
less nvasive
convenient
repeatable
acceptable
