MP323 - ANGINA

Question 1

ischaemia

Answer 1

• insufficiency in blood supply
• coronary artery is the only blood source for the heart
• coronary arteries are blocked, the blood supply to the heart will reduce, which may result in chest pain; angina

Question 2

angina pectoris (angina)

Answer 2

result of ischaemia caused by an imbalance between myocardial blood supply and oxygen demand
main symptom is chest pain

Question 3

3 types of pathophysiology of angina

Answer 3

stable
unstable
Prinzmetal’s

Question 4

unstable angina

Answer 4

• rapidly worsening chest pain on minimal exertion or at rest
• associated with an ulcerated atheroma and thrombus formation. produces a greater reduction of coronary blood flow to produce angina at rest.

Question 5

stable angina

Answer 5

occurs when coronary perfusion is impaired by fixed or stable atheroma of coronary arteries

Question 6

Prinzmetal’s angina

Answer 6

coronary artery spasm: sudden involuntary contraction of smooth muscle tissue in coronary artery

usually occurs at rest
spasm temporarily narrows the artery

Question 7

stable angina classification

Answer 7

1. exertional angina
2. angina equivalent syndrome
3. syndrome-X
4. silent ischaemia
5. decubitus angina
6. nocturnal angina

Question 8

exertional/classical angina

Answer 8

• arises from an increase in myocardial oxygen demand during exertion or emotion. relief occurs by rest and nitroglycerine
• coronary artery obstructions are not sufficient to result in resting myocardial ischaemia

Question 9

angina equivalent syndrome

Answer 9

• caused by myocardium ischaemia
• symptoms: shortness of breath, pain at other site than chest (e.g. arm or jaw)

Question 10

syndrome X

Answer 10

• typical, exertional angina with positive exercise stress test
• reduced capacity of vasodilation in microvasculature

Question 11

silent ischaemia

Answer 11

• very common
• difficult to diagnose
• Holter monitor
• exercise testing
• people with previous heart attack or diabetes are high risk

Question 12

decubitus angina

Answer 12

• chest pain occurs only when lying down (relieved by standing or sitting)
• associated with impaired left ventricular function and coronary artery disease
• cause: gravity redistributes fluids in body, makes heart work harder

Question 13

nocturnal angina

Answer 13

• awakes patient from sleep
• may be provoked by vivid dreams
• may occur due to coronary artery spasm

Question 14

Holter monitor

Answer 14

• portable device for cardiac monitoring
• monitors for 24 to 72hrs
• check for silent ischaemia
• continuously records ST segments for flat or down-sloping ST depression of 1 to 2 mm or more

Question 15

stable angina assessment

Answer 15

history: grading scale
exercise testing
electrocardiogram (ECG)

Question 16

class I of angina severity (4 classes)

Answer 16

angina only during strenuous or prolonged physical activity

Question 17

class II angina severity (4 classes)

Answer 17

slight limitation with angina only during vigorous physical activity

Question 18

class III angina (4 classes)

Answer 18

moderation limitation, symptoms with everyday living activities

Question 19

class IV angina (4 classes)

Answer 19

severe limitation, inability to perform any activity without angina or angina at rest

Question 19

stable angina - exercise testing

Answer 19

goal is to induced a controlled, temporary ischaemic state during clinical and ECG observation

Question 19

stable angina - ECG

Answer 19

ST segment depression occurs with ischaemia and reverses after ischaemia disappears

Question 20

atherosclerotic plaque and thrombus steps

Answer 20

1. initial fatty streak
2. plaque enlarges
3. loss of endothelium and exposure of collagen
4. platelet adherence and activation
5. fibrin meshwork deposition with RBC entrapment
6. more flow turbulence
7. thrombus of alternating layers of platelets, fibrin and RBCs

Question 21

angina symptoms first-line therapy

Answer 21

beta blockers + sublingual GTN

Question 22

inadequate control of symptoms of angina symptoms after first-line therapy

Answer 22

ADD A CALCIUM CHANNEL BLOCKER

beta blocker + calcium channel blocker + GTN

Question 23

angina treatment if intolerant of beta blockers

Answer 23

rate-limiting calcium channel blocker, long-acting nitrates or nicorandil

Question 24

angina symptom treatment if not controlled after drug therapy

Answer 24

refer to cardiologist if not controlled on maximum doses of two drugs