SIHD & Angina - Presentation Flashcards
What is stable angina?
Constricting chest pain with or without radiation to left arm/jaw. Stable when it is relived with GTN or rest.
Outline the pathophysiology of angina.
- mismatch between O2 supply/demand to myocardium
- main cause is atheroma in the coronary arteries
- less commonly: artery spasm, arteritis
- myocardial ischaemia leads to symptoms of angina
What are some precipitants of angina?
4
- exercise
- cold weather
- emotional stress
- heavy meal
Stable angina becomes symptomatic usually when obstructive plaque (atheroma) obstructs ____ of the artery lumen.
> 70%
What important things should be asked in a patient Hx?
5
- site of pain (retrosternal)
- radiation (arm, jaw)
- characteristic (tight band, pressure, heaviness)
- exacerbating factors (GTN, rest)
- aggravating factors (exercise)
What features point to something other than angina?
4
- sharp/stabbing pain (pleuritic, pericardial)
- very localised, pin point
- no pattern to pain (rest)
- onset (not after exercise)
Outline some differential diagnosis for different systems.
CVS: aortic dissection, pericarditis
Resp: pleurisy, pneumonia
MSK: costochondritis
GI: reflux, peptic ulceration
In what patients might myocardial ischaemia result in symptoms other than chest pain/angina?
diabetics/elderly
Outline non-modifiable risk factors.
4
Age
gender
family history
genetic factors
Outline modifiable risk factors.
5
- Smoking
- Lifestyle - exercise & diet
- Diabetes mellitus (glycaemic control reduces CV risk)
- Hypertension (BP control reduces CV risk)
- Hyperlipidaemia (lowering reduces CV risk)
What are clinical signs of stable angina?
6
- Tar stains on fingers
- Obesity (centripedal)
- Xanthalasma and corneal arcus (hypercholesterolaemia)
- Hypertension
- Abdominal aortic aneurysm arterial bruits, absent or reduced peripheral pulses.
- Diabetic retinopathy, hypertensive retinopathy on fundoscopy.
What are some signs of exacerbating or associated conditions?
5
- Pallor of anaemia
- Tachycardia, tremor, hyper-reflexia of hyperthyroidism
- Ejection systolic murmur, plateau pulse of aortic stenosis
- Pansystolic murmur of MR
- Signs of heart failure such as basal crackles, elevated JVP, peripheral oedema.
What investigations aid in diagnosing angina?
4
- Hx/exam
- Bloods
- CXR
- ECG (+/- ETT)
What blood tests would be carried out?
FBC UEs lipid profile HbA1c/fasting glucose LFTs TFT
What would a CXR help rule out or identify?
pulmonary oedema
