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Tim CP3 @ UoN - Medicine & Surgery > Chronic Stable Angina Pectoris > Flashcards

Chronic Stable Angina Pectoris Flashcards

1
Q

Define Stable Angina

A

Episodic pain caused by increased myocardial demand due to impaired perfusion

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2
Q

How much of an artery must be stenosed to cause angina?

A

> 70% of a main coronary artery

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3
Q

What precipitants are there of Angina?

A

Exercise
Emotion
Cold
Heavy meals

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4
Q

What symptoms are associated with Angina?

A

Dysponea
Nausea
Sweatiness
Faintness

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5
Q

What are the common causes of Angina?

A

ATHEROMA - CAD
Valvular heart disease
Cardiomyopathy
Anaemia

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6
Q

What are the risk factors for Angina?

A 
Smoking
Obesity
Hypertensive
DM
Raised cholesterol
Prev MI
Family history of CVD
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7
Q

Describe how CAD leads to Angina

A

CAD - coronary artery disease, thickening of arterial walls due to presence of atherosclerosis
Restricts passage of blood - hypoxia
Exacerbated on exertion

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8
Q

Describe how valvular heart disease leads to Angina

A

Aortic stenosis/regurgitation often lead to heart failure
Cause Left Ventricle Hypertrophy
Increased muscle mass but no increase in supply - angina

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9
Q

Describe how cardiomyopathy leads to Angina

A

Most commonly hypertrophic cardiomyopathy (HCM)

Increased muscle mass but no increase in supply - angina

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10
Q

Describe how anaemia leads to Angina

A

Lowered Hb/RBC in blood ie. reduced oxygen carrying capacity

Reduced Ox in blood - reduced Ox to heart - angina

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11
Q

What is Xanthelasmata?

A

Deposits of fat s.c. around eyes/nails
Sign of excess cholesterol
Suggestive of poss atheroma?

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12
Q

What is Tendon Xanthoma?

A

Papules/nodules of fat in tendons of hands/feet/heel

Sign of excess cholesterol (familial hypercholesterolaemia)

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13
Q

How is Hypertension related to Angina?

A

High BP causes damage to coronary arteries

Also increased requirements of heart to pump against raised BP

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14
Q

How is Hyperthyroidism related to Angina?

A

Hyperthyroidism causes
-tachycardia (can lead to AF)
-systolic hypertension
Both can lead to angina

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15
Q

What is Arteriosclerosis?

A

Non-specific thickening and hardening of arterial walls causing a loss of contractility/elasticity and decreased blood flow
Often due to prolonged HTN in smaller arteries

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16
Q

What is Atheroma?

A

Specific degenerative disease affecting large/medium size arteries

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17
Q

What is Atherosclerosis?

A

Thickening/hardening of arterial walls due to atheroma
Reduces tissue perfusion
Predisposes to thrombus/aneurysm formation

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18
Q

Describe the pathology of atheroma formation

A

Damage to endothelium allows LDLs to enter intima
Lipid taken up by macrophages –> FATTY STREAK

Macrophages release lipid into intima & stimulate cytokines –> collagen deposition –> FIBROTIC LIPID PLAQUE

Fibrotic plaque leads to atrophy of media/lamina –> fragile endothelium –> ULCERATION

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19
Q

What is the appearance of the initial fibrotic lipid plaque?

A

Raised

Yellow

20
Q

What is the appearance of the late stage fibrotic lipid plaque?

A

Hard

White

21
Q

How would a patient with suspected angina be investigated?

A 
ECG - often normal, may show
-ST depression, flat/inverted T waves (prev MI)
Angiography
Functional imaging
Coronary Artery Calcification Score
22
Q

What drugs are used to treat Angina?

A 
Aspirin
B-blockers
Nitrates - i.e. GTN spray
Calcium channel blockers
K+ channel activators - i.e. nicorandil
23
Q

How does Aspirin work?

A

Antiplatelet agent - limits thrombosis - decreased obstruction
Pain relief

24
Q

What are the common side effects of Aspirin?

A

Gastric damage (ie. ulcers)
Dyspepsia
Nausea/Vomiting

25
Q

How do B-blockers work?

A

-ve inotropic/chronotropic effects
Anti-arrhythmic effects
More time in diastole - increased coronary flow

26
Q

What are the common side effects of B-blockers?

A

Bronchospasm
Reduced hypoglycaemic awareness
Fatigue
Cardiac depression/bradycardia

27
Q

How do Nitrates work?

A

Release NO
Cause venodilation - decreased preload/cardiac work
Coronary vasodilatation

28
Q

What are the common side effects of Nitrates?

A 
Headaches
Flushing
Burning under the tongue
Postural hypotension
Dizziness
29
Q

How do Calcium Channel Blockers work?

A

Antagonise Calcium channels - hyperpolarisation
Vasodilatation
Verapamil also bradycardic/myocardial depressant/anti-arrhythmic

30
Q

What are the common side effects of Calcium Channel Blockers?

A

Flushing
Headaches
Peripheral oedema
Constipation

31
Q

How do K+ channel activators work?

A

Katp channel activated - hyperpolarisation

Vasodilatation & reduced work

32
Q

What are the common side effects of K+ channel activators?

A 
Headaches
Nausea/vomiting
Flushing
Dizziness
Abdominal pain
Ulcers
33
Q

What are the two common variants of stable angina?

A

Decubitus

Prinzmetal’s (variant)

34
Q

What is Decubitus angina?

A

Angina precipitated by lying down
Due to increased venous return
Associated w/ LVF

35
Q

What is Prinzmetal’s angina?

A

Occurs at rest

Due to coronary artery spasm

36
Q

What are the non-pharmacological treatment options for angina?

A

Angioplasty (PCTA)

Coronary Artery Bypass Grafting (CABG)

37
Q

Describe angioplasty (PTCA)

A

Percutaneous transluminal coronary angioplasty
Dilates coronary obstructions by inflating a catheter mounted balloon
Uses fluroscopy

38
Q

What are the risks of PTCA?

A

Local dissection of coronary artery
Acute coronary occlusion
1% mortality, 2% AMI

39
Q

What are the long term impacts of PTCA?

A

Improves sx
No prognostic benefit
Requires aspirin/clopidgorel

40
Q

Describe CABG

A

Replacement of diseased artery with healthy artery from elsewhere

41
Q

What are the indications for CABG?

A

Sx control for patients unsuitable for PCI

Patients w/ 3 vessel CAD

42
Q

What are the employment/driving limitations of ACS?

A

Work –> Office after 2mo, certain occupations should not return to work
Travel –> Avoid air travel for 2mo
Sex –> Avoid intercourse for 1mo
Driving –> DVLA not notified, start after 1-4wks

43
Q

What are the employment/driving limitations of angina?

A

DVLA not notified

Driving can continue unless angina occurs at rest, whilst driving or w/ emotion

44
Q

What are the employment/driving limitations of AAA?

A

Notify DVLA if >6cm

Annual review, license revoked if >6.5cm

45
Q

How do ACS/cardiac diagnoses affect HGV drivers?

A

Revoked license for 6weeks-3mo

Re-licensing at a later date

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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