IHD

Question 1

what’s angina?

Answer 1

is a symptom complex caused by imbalance bw demand and supply

Question 2

Mention the causes of Angina.

Answer 2

Atherosclerosis
AS
Hypertrophic obstructive cardiomyopathy
vasculitis, aortitis
coronory artry spasm
syndrome x

Question 3

explain breifly what is prinzmetal angina, syndrome x.

Answer 3

*variant angina with transient ST segment elevation.
*typical angina on effort objective evidence of myocardial ischemia on stress testing, normal coronory artry on angiography.

Question 4

Mention the factors influencing myocardial o2 demand and supply.

Answer 4

*demand:
HR, BP, contractility, LVH, valvular disease.
*supply:
duration of diastole, coronory vasomotor tone
oxygenation; hemoglobin, O saturation.
coronary perfusion pressure (aortic diastole minus RA diastolic pressure).

Question 5

Mention the Activities precipitating angina

Answer 5

1_physical and emotional stress
2_heavy meal
3_cold weather
4_lying flat (decubitus angina)
5_vivid dreams (nocturnal angina).

Question 6

Describe the CCS angina score

Answer 6

class 1_angina only during strenuous or prolonged activity.
2_slight limitation, angina only during vigorous physical activity.
3_moderate limitation, angina with everyday activity.
4_inability to perform any activity without angina or angina at rest.

Question 7

How to investigate a px with angina and what are the possible findings?

Answer 7

1_exercise ECG: planar or down sloping ST segment depression of 1mm or more is indicative of ischemia.
up sloping st segment depression is less specific (normal, false + in bundle branch block or digoxin therapy, WPW, LVH.
2_Stress echo
3_CT coronory arteriography: presence or absence of CAD, clarify the diagnosis, guide optimal treatment, avoid the need for cardiac catheter.

Question 8

Compare bw high risk and low risk px in risk stratification in stable angina.

Answer 8

1_high risk: post infarct angina
poor effort tolerance
ischemia at low workload
poor LV function
Lt main or three vessel disease.

2_predictable exertional angina
good effort tolerance
ischemia at high workload
good LVF
Single vessel or two disease

Question 9

How to manage a px with angina?

Answer 9

1_preventive therapy: aspirin
clopidogrel(dyspipsia with aspirin)
statins in all px.
2_antianginal drugs:
start with GTN and B blockers, then add Ca channel blockers or long actinv nitrate.
3_K channel activators, Ivabradine, Ranolazine
4_if failed, revascularization.

Question 10

Regarding nitrate:
1_pharmacological effect
2_used in acute attack?
3_SE
4_how to achieve more prolonged effect?
5_how to treat nocturnal angina?

Answer 10

1_dec cardiac demand by dec preload and afteoad, inc supply by coronary dilataion.
2_sublingula GTN, aerosol, buccal tablet, used as prophylaxis before exercise.
3_headache, hypotension, syncope, tolerance.
4_transcutanous patch of GTN, slow release buccal tablet, oral isosorbide mono and trinitrate
5_give long acting nitrate at the end of the day.