SIHD and angina Flashcards
signs of stable angina
retrosternal pain, tight, pressure, heavy pain, can radiate into neck or jaw or down arms, aggravated by exercise or stress and relieved by stopping physical activity or GTN
angina is
a discomfort in the chest and or adjacent areas associated with myocardial ishaemia but without myocardial necrosis
medical therapy for stable angina
statins if total cholesterol greater than 3.5mmol/l, ACE inhibitors if increased CV risk and atheroma, aspirin (75mg), beta blockers or calcium channel blockers or Ik channel blockers (to reduce heart rate to less than 60bpm), nitrates
percutaneous coronary intervention
cross stenotic lesion with guidewire and squash atheromatous plaque into arterial walls with balloon and stent. patients need to be on antiplatelet medication so it is no longer seen as a foreign body with associated risk of thrombosis. effective for symptoms but does not improve prognosis
coronary artery bypass grafting
often best option, good lasting benefit but the up front risks are significant. may confer prognostic benefit in certain subgroups- less than 70% stenosis of left main stem artery, significant three vessel coronary artery disease, two vessel coronary artery disease that includes significant stenosis of proximal left anterior descending coronary artery and who have ejection fraction less than 50%
investigations for stable angina
bloods (full blood count, lipid and fasting glucose profile, liver and thyroid tests, electrolytes), CXR, ECG (normal in over 50% of cases but may show prior myocardial infarction or left ventricular hypertrophy), exercise tolerance test, myocardial perfusion imaging, CT, echo stress ultrasound, cardiac catheterisation or coronary angiography
severity is judged by what system
CCS class 1 is less severe eg only on significant exertion and class 4 is most eg pain on getting dressed or washed
unstable angina
symptoms when you do very little or resting
risk factors for stable angina
more common in men, older, caucasians, smoking, poor lifestyle, hypertension, diabetes, hyperlipidaemia
examination signs
tar staining, obesity, xanthalasma, corneal arcus, hypertension, abdominal aortic aneurysm arterial bruits, absent or reduced peripheral pulses, diabetic retinopathy, hypertensive retinopathy on fundsocopy, tachycardia, signs of heart failure, pallor of anaemia, ejection systolic murmur, pansystolic murmur of mitral regurgitation
myocardial perfusion imaging
radionuclide tracer injected at peak stress on one occasion, images obtained and at rest on other. tracer seen at rest but not stress = ischaemia or tracer seen neither rest or after stress = infarction
what take if intolerant to aspirin
clopidogrel
what do statins do
reduce LDL cholesterol deposition in atheroma and also stabilise atheroma reducing plaque rupture and ACS
what do ACE inhibitors do
stabilises endothelium and reduces plaque rupture
what does aspirin do
protects endothelium and reduces platelet activation/ aggregation
