IHD - Stable Angina Flashcards
Definition
Chest pain caused by an insufficient blood supply to the myocardium
Features of stable anginal chest pain - 3
- crushing pain that may radiate to jaw/neck/arm
- brought on by exertion
- alleviated by rest or a GTN spray
Criteria of typical and atypical stable anginal pain
3/3 features - typical
2/3 - atypical
0-1/3 - non-anginal pain
Risk Factors for Angina - 8
Non-mod:
1. Age
2. Gender (men)
3. FH
4. Ethnic backround
Modifiable:
1. Smoking
2. high level of non-HDL cholesterol
3. obesity and poor diet
4. alcohol
Classification of stable angina pain
Class I - angine only during strenuous activity, none with normal physical activity
Class II - angina pain causes limitation on normal physical acitivity
Class III - angina causes marked limitation on normal physical activity
Class IV - angina occurs with any physical activity and may occur at rest (bordering on unstable ang)
Differential diagnosis of stable angina - 4
ACS
GORD
Costochondritis
Pleuritic chest pain e.g. PE, pneumonia
Investigations of angina - 6
In Primary Care:
* ECG - assess for ischaemic changes
* FBC and TFTs (excludes anaemia and hyperthyroidism)
1st line
* CTCA
2nd line
* Echocardiogram
* Cardiac MRI
3rd
* invasive coronary angiography
Conservative management of stable angina - 6
- smoking cessation
- glycaemic control
- HTN control
- Weight loss
- Lipid control
- Alcohol intake
Immediate medical management of stable angina - 2
- Aspirin (low dose) 75mg OD and statin 80mg ON
- GTN spray for symptom relief
Long term medical management for stable angina - 3 lines
1st line - beta blocker (bisoprolol) OR CCB (verapamil or diltiazem)
2nd line - beta blocker AND dihydropyridine CCB (amlodipine or nifedipine)
3rd line - bisoprolol AND dihydropryridine CCB AND long acting nitrate
Surgical management of stable angina
Revascularisation with a coronary artery bypass graft - only done if symptoms not controlled by meds
How does stable angina present on an ECG - 3
- pathological Q waves
- LBBB
- ST elevation
