Stable angia Flashcards
What is the most common cause on aginal symptoms ?
Obstructive coronary disease
What is an uncommon cause of anginal symptoms?
Coronary artery spasm
What is a very rare cause of anginal symptoms?
Coronary inflammation
What condition of the blood can cause angina?
Anaemia
What can cause angina symptoms but is uncommon?
- LVH
- Throtoxicosis
What cause left ventricular hypertrophy?
Persistent hypertension
- Sig stenoisis of aorta
- Hypertrophic cardiomyopathy
What happens when exercising with stable angina?
- Increased myocardial oxygen demand
- Obstructed coronary flow leads to myocardial ischaemia and then the symptoms of angina
What can cause excess myocardial oxygen demand?
- Exertion
- cold wheather
- emotional stress
What causes acute coronary syndromes?
Spontaneous plaque
rupture & local thrombosis, with degrees of occlusion
Where is site of pain for angina?
Rertosternal
What is the character of pain with stable angina?
Tight band pressure
Where does angina pain radiate to?
neck/jaw/down arms
What would other symptoms of stable angina be without chest pain?
- Breathless on exertion
- Excessive fatigue on exertion
- Near syncope on exertion
What is class 1 angina?
Ordinary physical activity does not cause angina, symptoms only on significant exertion
What is class 2 angina?
Slight limitation of ordinary activity, symptoms on walking 2 bloacks or > 1 flight of stairs
What is class 3 angina?
Marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs
What is class 4 angina?
Symptoms on any activity, getting washed/dressed causes symptoms
What can be found on examining a patient with stable angina?
- Tar staining
- Obesity
- Xanthalasma and corneal arcus
- Hypertension
- Abdominal aortic aneurysm arterial bruits, absent or reduced peripheral pulses
- Diabetic retinopathy
How do you discover hypertensive retinopathy?
Fundoscopy
What are the signs of exacerbating or associated conditions?
- Pallor of anaemia
- Tachycardia,trmor, hyper-reflexia of hyperthyroidism
- Ejection of systolic murmur, plateau pulse of aortic stenosis
- Signs of heart failure?
What are the signs of heart failure?
basal crackles, elevated JVP
Peripheral oedema
What does an ecg show for stable angina?
Normal in over 50% of cases
What can be found incidentally on ECG with stable angina?
Evidence of prior myocardial infarction (ie Pathological Q-waves)
What shows evidence of left ventricular hypertrophy?
high voltages
lateral ST-segment depression or “Strain pattern”
What is the test for diagnosis stable angina?
Exercise tolerance test
What is needed for a diagnosis?
A positive ECG ( ST-segment depression)
AND
typical symptoms
Does ETT rule out significant coronary atheroma?
NO- but if negative at high workload overall prognosis is good.
What does a stint do?
dilates all the blood vessels
What is the use of myocardial perfusion imaging?
Detection of CAD
Localisation of ischaemia
Assessing size of affected areas
What drugs can be given to simulate exercise?
Adenosine,
dipyridamole/ dobutamine
What would you diagnose if tracer is seen at rest but not after stress
-Ischaemia
Tracer seen neither at rest or stress
-Infarction
When would you preform invasive angiography?
- 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?
How does a cardiac catheterisation get to cornoary arteries?
-Cannula inserted into femoral or radial artery
passed to aortic root and introduced into the ostium of coronary arteries
What are the three stages of treatment of stable angina?
- General measures
- Medical treatment
- Revascularisation
What general measures can be taken to reduce angina?
BP
Diabetes mellitus
Cholesterol
Lifestyle
When is re vascularisation used?
-If symptoms are not controlled
What does PCI stand for?
Percutaneous coronary intervention
What does CABG stand for?
Coronary artery bypass grafting
When should statins be considered?
Considered >3.5 mmol/l
What do statins do?
reduce LDL-cholesterol depostion in atheroma and also stabilis atheroma reducing plaque rupture
What do ACE inhibitors do?
stabilise endothelium and also reduce plaque rupture
What does aspirin do?
may not directly affect plaque but does protect endothelium and reduces of platelet activation/aggregation
What would you prescribe to someone who is allergic to aspirin?
Clopidogrel
What is the dose of aspirin normally prescribed?
75mg
What is given for relief of symptoms?
- B-Blockers
- Ca2+ channel blockers
- IK channel blockers
-Beta-blockers are used to achieve what?
<60bpm
\What do beta blockers do?
reduce myocardial work and have anti-arrhythmic effects
What do calcium channel blockers do?
Central acting
What are the names of some Ca2+ blockers
ditiazem/verapamil
Name a IK channel blocker?
Ivabridine is a new medication which reduces sinus node rate
What calcium channel blockers produce vasodilation?
peripheral acting dihydropyridines
Eg: Amlodipine felodipine
What nitrates produce vasodilation?
GTN
Name a K+ channel blocker?
nicorandril
What does PCI?
percutaneous coronary intervention
What does PTCA?
percutaneous transluminal cornary angioplasty
Whats the difference between PCI and PTCA?
Start the same
but crosses stenoitic lesion with guidewire and squash atheromatous plaques into walls with ballons and stent
What happens if stent is used in PTCA?
aspirin and clopidogrel taken togetherwhilst endothelium covers the stent struts and it is no longer seen as a foreign body with risk of thrombosis
Will PCI improve prognosis?
no evidence of this
What does CABG stand for?
Coronary artery bypass surgery
