Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine - Cardiology > Chronic - Stable angina > Flashcards

Chronic - Stable angina Flashcards

1
Q

Describe the features of typical angina

A

ALL 3

  • Constricting discomfort in the chest, neck, shoulders or jaw
  • Precipitated by exercise
  • Relieved by rest or GTN within 5 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Is stable angina an acute coronary syndrome?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stable angina is typically predictable and reproducible. Is each episode of chest pain brought on by the same type and amount of exercise?

A

Not necessarily - this can vary from one occasion to another

In particular, the chest pain may come on earlier when exercising after a meal or when in a cold environment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Does stable angina undergo rapid worsening over time?

A

no - that is why it is called ‘stable’ angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the main aims of treatment for stable angina?

A
  • PRN symptom relief
  • anti-anginal medication
  • secondary prevention of CVD disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is included in the first-line management of stable angina?

A
  • PRN symptom relief - GTN spray
  • Anti-anginal medication - Bisoprolol or Verapamil
  • Secondary prevention of CVS disease - lifestyle advice, control HTN, ACEi if diabetes, aspirin 75mg OD, atorvastatin 80mg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What would you look for on examination if you think the patient may have coronary artery disease?

A
  • Signs of CVS risk factors (BMI, xanthoma, xanthelasma),
  • Signs of damage (heart sounds, signs of heart failure)
  • Signs of procedures: check for a midline sternotomy scar (previous CABG), scars around the brachial and femoral arteries (previous PCI) and along the inner calves (saphenous vein harvesting scar)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What specific questions would you ask if you are suspecting coronary artery disease?

A

SQUITARS, associated symptoms e.g. breathlessness

PMH - previous MI/stroke

SH - smoking, alcohol, exercise, diet

FH - MI/stroke/PVD, if yes - what age?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is atypical angina?

A

2 of:

  • Constricting discomfort in the chest, neck, shoulders or jaw
  • Precipitated by exercise
  • Relieved by rest or GTN within 5 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is non-anginal chest pain?

A

1 or 0 of:

  • Constricting discomfort in the chest, neck, shoulders or jaw
  • Precipitated by exercise
  • Relieved by rest or GTN within 5 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should be done if the chest pain is classed as ‘non-anginal’?

A
  • Consider other causes of chest pain other than angina
  • Only consider CXR if other diagnoses e.g. lung cancer are suspected
  • Do not offer diagnostic testing to people with non-angina chest pain on clinical assessment unless there are resting ECG changes (ST or Q waves)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What factors can trigger angina?

A
  • Exertion
  • Emotional stress
  • Exposure to cold
  • Eating a large mea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Should treatment for stable angina be initiated without the results of definitive investigations?

A

yes - Follow the recommendations on managing stable angina while waiting for the results of investigations if symptoms are typical of stable angina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What advice would you give regarding the use of a GTN spray?

A

Indication: Preventing and treating episodes of angina

  • Immediately before any planned exercise or exertion

Instructions: If they experience chest pain they should:

  • Stop what they are doing and rest
  • Use GTN spray as instructed
  • Take a second dose after 5 mins if the pain has not eased
  • Call 999 if pain has not eased 5 mins after the second dose, or earlier if the pain is intensifying

Side effects:

  • flushing, headache, light-headedness (sit down or find something to hold on if feeling light-headed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the 1st line anti-anginal medication?

A

beta-blocker (bisoprolol)/calcium-channel blocker (amlodipine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

1st line anti-anginal treatment of stable angina is either a beta blocker or calcium channel blocker. What should be done if this does not control symptoms?

A

Referral to cardiologist for specialist treatment with monotherapy of one of the following:

  • Long-acting nitrate – isosorbide mononitrate
  • Nicorandil
  • Ivabradine
  • Ranolazine
17
Q

What drugs are given for secondary prevention in stable angina?

A

Secondary prevention treatment – to prevent CVS events such as MI/stroke (4As)

Anti-platelet treatment taking into account bleeding risk and comorbidities – aspirin

ACEi if stable angina and diabetes mellitus

Statin – atorvastatin

Anti-hypertensive treatment if appropriate

18
Q

What safety netting advice would you give someone with stable angina?

A

Call 999 if:

  • pain has not eased 5 mins after the second dose of GTN, or earlier if the pain is intensifying after
  • Pain at rest
  • Pain on minimal exertion
19
Q

Most patients with stable angina are initially successfully managed by their GP. When would a patient with stable angina be referred to a cardiologist?

A

Basically pre-existing or co-existant cardiac disease complicating the angina -

  • Previous myocardial infarction, coronary artery bypass graft, or percutaneous transluminal coronary angioplasty and development of angina.
  • ECG (electrocardiographic) evidence of previous myocardial infarction or other significant abnormality.
  • Newly diagnosed atrial fibrillation and angina.
  • Heart failure and angina.
  • An ejection systolic murmur suggesting aortic stenosis.
  • Any suggestion of hypertrophic cardiomyopathy (for example by family history, physical examination, or ECG).
20
Q

Which initial investigations would be carried out on a patient presenting with a history of chest pain?

A

Resting 12-lead ECG

  • Do not rule out a diagnosis of stable angina on the basis of a normal resting 12-lead ECG
  • May indicate ischaemia or previous infarction:
    • Pathological Q waves
    • LBBB
    • ST-segment and T wave abnormalities

Bloods - troponin T/I and creatine kinase (if current chest pain), FBC (anaemia), U&E’s (ACEi), LFTs (statin), lipid profile (statin), TFTs, HBA1c (diabetes)

21
Q

Which diagnostic investigations are carried out on patients presenting with symptoms of typical or atypical angina?

A

CTCA (first line) – inject contrast and taking CT images timed with the heart beat to give a detailed view of the coronary arteries, highlighting any narrowing

22
Q

Should patients presenting with non-anginal chest pain be referred for CTCA?

A

Indicated in non-angina chest pain if 12-lead resting ECG shows ST segment/T wave changes or Q waves

23
Q

When is non-invasive functional testing carried out?

A

CTCA has shown coronary artery disease of uncertain functional significance or is on-diagnostic

24
Q

What is non-invasive functional testing?

A
  • Myocardial Perfusion Scan with SPECT
  • Stress echocardiography
  • First-pass contrast-enhanced magnetic resonance perfusion
  • MRI for stress-induced wall motion abnormalities
25
Q

When is invasive angiography indicated for the investigation of stable angina?

A

Results of non-invasive functional imaging are inconclusive

26
Q

What are the 1st, 2nd and 3rd line investigations for stable angina?

A
  1. CT coronary angiogram
  2. Non-invasive functional testing
  3. Invasive coronary angiography
27
Q

What is PCI?

A

Involves putting a catheter into the patient’s brachial or femoral artery, feeding that up the coronary arteries under xray guidance and injecting contrast so that the coronary arteries and any areas of stenosis are highlighted on the xray images. This can then be treated with balloon dilatation followed by insertion of a stent

28
Q

What is CABG and how does it compare to PCI?

A
  • Involves opening the chest along the sternum (midline sternotomy scar), taking a graft vein from the patient’s leg (usually the great saphenous vein) and sewing it on to the affected coronary artery to bypass the stenosis
  • Recovery is slower and complication rate is higher than PCI
29
Q

When would PCI/CABG be considered in patients with stable angina?

A
  • Symptoms NOT satisfactorily controlled with optimal medical treatment
  • Investigations shows proximal or extensive coronary artery disease
30
Q

As a GP seeing a patient with first presentation suspected stable angina, you would do the initial investigations (12-lead ECG and bloods). Then, how would you confirm the diagnosis of stable angina?

A

If the person has typical or atypical anginal pain, refer them to a specialist chest pain service to confirm, or exclude the diagnosis of stable angina.

Include a description of the features of anginal chest pain in all requests for diagnostic investigations - CTCA is 1st line.

Medicine - Cardiology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions