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Systems: Cardiovascular > Stable angia > Flashcards

Stable angia Flashcards

1
Q

What is the most common cause on aginal symptoms ?

A

Obstructive coronary disease

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2
Q

What is an uncommon cause of anginal symptoms?

A

Coronary artery spasm

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3
Q

What is a very rare cause of anginal symptoms?

A

Coronary inflammation

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4
Q

What condition of the blood can cause angina?

A

Anaemia

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5
Q

What can cause angina symptoms but is uncommon?

A
  • LVH

- Throtoxicosis

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6
Q

What cause left ventricular hypertrophy?

A

Persistent hypertension

  • Sig stenoisis of aorta
  • Hypertrophic cardiomyopathy
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7
Q

What happens when exercising with stable angina?

A
  • Increased myocardial oxygen demand

- Obstructed coronary flow leads to myocardial ischaemia and then the symptoms of angina

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8
Q

What can cause excess myocardial oxygen demand?

A
  • Exertion
  • cold wheather
  • emotional stress
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9
Q

What causes acute coronary syndromes?

A

Spontaneous plaque

rupture & local thrombosis, with degrees of occlusion

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10
Q

Where is site of pain for angina?

A

Rertosternal

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11
Q

What is the character of pain with stable angina?

A

Tight band pressure

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12
Q

Where does angina pain radiate to?

A

neck/jaw/down arms

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13
Q

What would other symptoms of stable angina be without chest pain?

A
  • Breathless on exertion
  • Excessive fatigue on exertion
  • Near syncope on exertion
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14
Q

What is class 1 angina?

A

Ordinary physical activity does not cause angina, symptoms only on significant exertion

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15
Q

What is class 2 angina?

A

Slight limitation of ordinary activity, symptoms on walking 2 bloacks or > 1 flight of stairs

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16
Q

What is class 3 angina?

A

Marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs

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17
Q

What is class 4 angina?

A

Symptoms on any activity, getting washed/dressed causes symptoms

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18
Q

What can be found on examining a patient with stable angina?

A
  • Tar staining
  • Obesity
  • Xanthalasma and corneal arcus
  • Hypertension
  • Abdominal aortic aneurysm arterial bruits, absent or reduced peripheral pulses
  • Diabetic retinopathy
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19
Q

How do you discover hypertensive retinopathy?

A

Fundoscopy

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20
Q

What are the signs of exacerbating or associated conditions?

A
  • Pallor of anaemia
  • Tachycardia,trmor, hyper-reflexia of hyperthyroidism
  • Ejection of systolic murmur, plateau pulse of aortic stenosis
  • Signs of heart failure?
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21
Q

What are the signs of heart failure?

A

basal crackles, elevated JVP

Peripheral oedema

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22
Q

What does an ecg show for stable angina?

A

Normal in over 50% of cases

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23
Q

What can be found incidentally on ECG with stable angina?

A

Evidence of prior myocardial infarction (ie Pathological Q-waves)

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24
Q

What shows evidence of left ventricular hypertrophy?

A

high voltages

lateral ST-segment depression or “Strain pattern”

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25
Q

What is the test for diagnosis stable angina?

A

Exercise tolerance test

26
Q

What is needed for a diagnosis?

A

A positive ECG ( ST-segment depression)
AND
typical symptoms

27
Q

Does ETT rule out significant coronary atheroma?

A

NO- but if negative at high workload overall prognosis is good.

28
Q

What does a stint do?

A

dilates all the blood vessels

29
Q

What is the use of myocardial perfusion imaging?

A

Detection of CAD
Localisation of ischaemia
Assessing size of affected areas

30
Q

What drugs can be given to simulate exercise?

A

Adenosine,

dipyridamole/ dobutamine

31
Q

What would you diagnose if tracer is seen at rest but not after stress

A

-Ischaemia

32
Q

Tracer seen neither at rest or stress

A

-Infarction

33
Q

When would you preform invasive angiography?

A
  • Early or strongly positive ETT
  • Angina refractory to medical therapy
  • Diagnosis not clear after after non-invasive tests
  • Young cardiac patients due to work/life effects
  • Occupation or lifestyle with risk?
34
Q

How does a cardiac catheterisation get to cornoary arteries?

A

-Cannula inserted into femoral or radial artery

passed to aortic root and introduced into the ostium of coronary arteries

35
Q

What are the three stages of treatment of stable angina?

A
  • General measures
  • Medical treatment
  • Revascularisation
36
Q

What general measures can be taken to reduce angina?

A

BP
Diabetes mellitus
Cholesterol
Lifestyle

37
Q

When is re vascularisation used?

A

-If symptoms are not controlled

38
Q

What does PCI stand for?

A

Percutaneous coronary intervention

39
Q

What does CABG stand for?

A

Coronary artery bypass grafting

40
Q

When should statins be considered?

A

Considered >3.5 mmol/l

41
Q

What do statins do?

A

reduce LDL-cholesterol depostion in atheroma and also stabilis atheroma reducing plaque rupture

42
Q

What do ACE inhibitors do?

A

stabilise endothelium and also reduce plaque rupture

43
Q

What does aspirin do?

A

may not directly affect plaque but does protect endothelium and reduces of platelet activation/aggregation

44
Q

What would you prescribe to someone who is allergic to aspirin?

A

Clopidogrel

45
Q

What is the dose of aspirin normally prescribed?

A

75mg

46
Q

What is given for relief of symptoms?

A
  • B-Blockers
  • Ca2+ channel blockers
  • IK channel blockers
47
Q

-Beta-blockers are used to achieve what?

A

<60bpm

48
Q

\What do beta blockers do?

A

reduce myocardial work and have anti-arrhythmic effects

49
Q

What do calcium channel blockers do?

A

Central acting

50
Q

What are the names of some Ca2+ blockers

A

ditiazem/verapamil

51
Q

Name a IK channel blocker?

A

Ivabridine is a new medication which reduces sinus node rate

52
Q

What calcium channel blockers produce vasodilation?

A

peripheral acting dihydropyridines

Eg: Amlodipine felodipine

53
Q

What nitrates produce vasodilation?

A

GTN

54
Q

Name a K+ channel blocker?

A

nicorandril

55
Q

What does PCI?

A

percutaneous coronary intervention

56
Q

What does PTCA?

A

percutaneous transluminal cornary angioplasty

57
Q

Whats the difference between PCI and PTCA?

A

Start the same

but crosses stenoitic lesion with guidewire and squash atheromatous plaques into walls with ballons and stent

58
Q

What happens if stent is used in PTCA?

A

aspirin and clopidogrel taken togetherwhilst endothelium covers the stent struts and it is no longer seen as a foreign body with risk of thrombosis

59
Q

Will PCI improve prognosis?

A

no evidence of this

60
Q

What does CABG stand for?

A

Coronary artery bypass surgery

Systems: Cardiovascular (31 decks)

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