CVD - Angina and Peripheral Vascular Disease

Question 1

What are the 2 types of angina pectoris?

Answer 1

• “classical” angina - No symptoms at rest, worse with exercise
• unstable angina - symptoms at rest

Question 2

Do you get biomarker elevation (troponin rise) with either types of angina?

Answer 2

no - there is no tissue death

Question 3

What are the symptoms of classical angina?

Answer 3

• no pain at rest
• Chest pain which may radiate to left arm, neck, back or jaw with certain level of exertion (worse with cold weather/emotion)
• Pain relieved by rest
• Patient lives within limits of tolerance
• Gradual deterioration of exercise tolerance

Question 4

What are the signs of classical angina?

Answer 4

Often none
but occasionally precipitated by another reason as to why they have a miss match between oxygen delivery and oxygen requirement such as:
- anaemia
- hyperthyroidism
- hypovolaemia

Question 5

What are the investigation for angina?

Answer 5

• ECG at resting and exercise ( at rest will generally show no changes but during exercise ischaemia may become visible)
• Eliminating other disease - anything that increases the cardiac work load (thyroid, anaemia, valve)
• Angiography - using a dye to look at the patency of the arteries
• Echocardiography - using ultrasound to look at the function of the heart valves and the function of ventricles
• radioisotope studies

Question 6

What are the treatment options for angina?

Answer 6

• Reduce oxygen demands of the heart
  = reducing afterload (BP)
  = reducing preload (venous filling pressure)
  = correct mechanical issues - failing heart valves, septal defects
• Increase oxygen delivery to the tissues
  = dilate blocked/narrowed vessels (angioplasty)
  = Bypass blocked/narrowed vessels (CABG - coronary artery bypass grafting)

Question 7

What are the non-drug therapy options for angina?

Answer 7

• explanation of the illness (live within limitations, this is adequate for some people who have limited activity/mobility)
• modify risk factors (such as stop smoking, graded exercise programme, improve diet/ control cholesterol)

Question 8

what are the drug therapy options for angina?

Answer 8

• reduce risk for myocardial infarction (ASPRIN)
• hypertension (diuretics, Ca channel antagonists, ace inhibitors, beta blockers)
• reduce heart filling pressure /dilate coronary vessels (nitrates - short acting and long acting)
• Emergency treatment (GTN spray/tab - short shelf live, reduced preload)

Question 9

where is GTN adminitered?

Answer 9

sublingually due to first pass metabolism

Question 10

What surgical therapy for coronary heart diseases is higher risk but higher benefit?

Answer 10

CABG - coronary artery by pass graft

Question 11

what are the 2 surgical therapy options for coronary artery disease?

Answer 11

CABG - coronary artery by pass graft
ANgioplasty and stenting