Condition- Ischaemic Heart Disease Flashcards
Define what angina pectoris is…
Chest pain or discomfort due to myocardial ischaemia which is brought on by exertion and relieved by rest.
Briefly describe the pathophysioloy behind angina
- Atheromatous plaque leads to stable obstruction of coronary artery
- Imbalance between myocardial oxygen supply and demand
List some of the risk factors for developing IHD
- smoking
- hypertension
- hyperlipidaemia
- isolated low HDL cholesterol
- diabetes
- inactivity
- obesity
- family history of premature coronary heart disease
- male sex
- illicit drug use
Describe the different classifications of Angina
- STABLE: indued on exertion, relieved by rest
- UNSTABLE: worsening + increasing frequency. Minimal exertion
- DECUBITUS: on lying down. Pooling of blood in legs when stading –> lying –> increased preload and myocardial work (HF complication)
- PRINZMETAL: Due to Coronary artery spasms often noticed at night. . The angina is associated with transient ST elevation (bunny ears) during attacks and negative stress ECG.
Describe the presentation of patients with angina
TYPICAL SYMPTOMS:
- Central chest tightness lasting several minutes
- Provoked by exercise or stress
- Relieved with rest or glyceryl trinitrate
ATYPICAL SYMPTOMS:
- May radiate to one or both arms, neck, jaw or teeth
- Associated symptoms: dyspnoea, nausea, sweatiness, faintness
List some of the signs on physial examination of a patient with angina
- USUALLY NORMAL
- might see tachycardia- this could bring on an angina episode
Which investigations could you perform on a patient with Angina?
- Resting ECG- usually normal, may see some ST depression indicative of ischaemic changes
- FBC- anaemia exacerbates angina
- Fasting Lipid Profile: elevated LDL is a risk
- HbA1c: hypergylcaemia is a part of the metabolic syndrome associated with IHD
How would you manage a patient with stable angina?
- Lifestyle advice: reduce risk of future cardiovascular events- weight management, increased physical activity, dietary modifications, lipid goals, and smoking cessation
- Antiplatelet therapy
- Anti-anginal therapy:
- Beta Blockers
- CCBs e.g. amlodopine
- Nitrates- GTN
- Metabolic Syndrome Management:
- Statins
- BG management
- Hypertensive control
List some of the contra- indications for pescribing Beta Blocker…
- Asthma
- Bradycardia, AV Block
- PVD
- Depressio
List some of the side-effects of Beta Blockers
- Fatigue
- Lethargy
- Restlessness
- Impotence in men
What is Ischaemic Heart Disease?
Characterised by decreased blood supply to the heart muscle resulting in chest pain (angina pectoris). May present as stable angina or acute coronary syndrome
Descirbe what Acute Coronary Syndrome is and what it can be subdivided into?
A spectrum of acute myocardial ischaemia and/or infarction subdivided into:
- UNSTABLE ANGINA: chest pain at rest due to ischaemia but without cardiac ijury
- NSTEMI: severly occluded coronary artery but not completely blocked
- STEMI: ST elevation with transmural infarction
List the causes of Angina Pectoris
A VASE
- Atheroschlerosis
- Vasculitis
- Arteritis
- Spasms
- Emboli
List some of the presenting symptoms of ACS
Chest Pain:
- S: central chest pain
- O: Acute onset during rest
- C: heavy, tight, crushing
- R: radiates to arms, neck, jaw or epigastrium
- A: SOB, sweating, palpitations, nausea and vomitting, syncope
- T: worse than stable angina + increasing frequency. Episodes >20mins
- E: Relieved by GTN but not rest
List some of the signs you may see on physical examination of someone with ACS…
- May be NO CLINICAL SIGNS
- INSPECTION: Pale, Sweating, restless, distress
- PALPATION: high/ low pulse may be poor, arryhtmias, BP disturbance
- AUSCULATION: New S4 sound, carotid bruits, murmur, rales (if LV failure)
- Signs of complications (e.g. acute heart failure, cardiogenic shock)
- Signs of heart failure are increased JVP, 3rd heart sound, basal crepitations
