Lecture 2 stable angina Flashcards
Describe the presentation of stable angina.
Stable angina is characterized by chest pain behind the breastbone, often felt on the left side of the chest and can radiate to the lower jaw, teeth, between shoulder blades, and left arm to wrists/fingers. It is triggered most commonly by physical exertion.
Define the pathophysiology of stable angina.
Stable angina is caused by reduced blood and oxygen flow to the heart muscle, leading to angina pain. It is typically triggered by activities that increase the heart’s demand for oxygen.
How is stable angina diagnosed?
Stable angina is initially suspected based on clinical assessment and the typical chest pain presentation. Immediate relief can be achieved with GTN sublingual spray.
Do other conditions besides reduced blood flow cause stable angina?
Less commonly, stable angina can also be caused by valvular disease (e.g., aortic stenosis), cardiomyopathy, or hypertensive heart disease.
Describe the character and duration of stable angina pain.
Stable angina pain is described as pressure, tightness, heaviness, constricting, or burning. It typically lasts for a brief period, up to 10 minutes, with longer durations suggesting other causes besides angina.
Describe the symptoms of angina.
Constricting discomfort in the chest, neck, shoulders, jaw, or arms, often precipitated by physical exertion and relieved by rest or glyceryl trinitrate within about 5 minutes.
What are some risk factors for angina?
Increased age, male gender, family history, South Asian ethnicity, low socioeconomic status, alcohol consumption, type two diabetes, dyslipidemia, smoking, hypertension, overweight, and physical inactivity.
How is angina typically diagnosed?
Through tests such as CT coronary angiography and exercise ECG, as well as invasive procedures like coronary angiography.
What are the first-line treatments for angina?
First-line anti-anginal medications include beta-blockers or calcium-channel blockers, with specific options like amlodipine, diltiazem, and bisoprolol, gradually titrated to appropriate doses.
What are some unsuitable combinations of medications for angina treatment?
Combining beta-blockers with rate-limiting calcium-channel blockers is considered unsuitable in the management of angina.
Describe the second-line treatment options for anti-angina medication.
Second-line treatment options include long-acting nitrates (e.g., isosorbide mononitrate), nicorandil, ivabradine, and ranolazine.
What is the recommended secondary prevention antiplatelet therapy and statin dosage?
The recommended secondary prevention antiplatelet therapy is aspirin 75mg OD or clopidogrel 75mg OD if contraindicated or not tolerated. The statin dosage is 80mg OD as first-line therapy.
How should the dosage of ISMN MR be adjusted for anti-angina treatment?
The initial dosage of ISMN MR is 25mg OD, which can be gradually increased to 120mg OD.
Define triple therapy in the context of anti-angina treatment.
Triple therapy refers to the use of three anti-anginal drugs concurrently when dual therapy is not effective, while awaiting specialist assessment.
Do you add a third anti-anginal drug in triple therapy if dual therapy is not effective?
Yes, a third anti-anginal drug is added in triple therapy if dual therapy is not effective, choosing the most suitable second-line agent from nitrate, nicorandil, ivabradine, or ranolazine.
