Stable Angina (1) Flashcards
What’s its pathophysiology?
What are its risk factors?
➊ Sclerotic narrowing of coronary arteries, therefore leading to reduced perfusion on exertion (when demand of the heart increases)
➋ • Elderly
• Male
• IHD
• FHx
• CVS risk factors e.g. Smoking, HTN, DM, Obesity, Hyperlipidaemia
How does it present?
→ What is it called if only 2 of these features are present?
What would make its diagnosis less likely?
➊ • Constricting/Heavy chest pain, with radiation to jaw/neck/left arm
• Symptoms brought on by exertion
• Symptoms relieved by rest or GTN
→ Atypical Angina
➋ • Continuous/prolonged pain despite 2 doses of GTN
• Unrelated to activity
• Pleuritic pain
• Associated dizziness, palpitations, tingling, or dysphagia
What’s the 1st line investigation to do?
→ In which pts should this not be done? What’s the alternative?
What other investigations should be done?
➊ CT Coronary Angiogram
→ Those with renal impairment. Do a myocardial perfusion scan instead.
➋ • ECG - usually normal
• Bloods - FBC (exclude anaemia), TFTs (exclude hyperthyroid), U&Es, LFTs, Lipid profile, Glucose
• Echo
Management:
What are the lifestyle changes to make?
What should all pts be started on?
At what point should the pt seek medical attention?
What’s the 2nd line option?
What’s the last option?
→ When should this be considered?
➊ • Smoking cessation
• Reducing alcohol
• Weight loss
• Diet
• Better diabetic/pressure control
➋ • Sublingual GTN - for rapid relief of symptoms
• Long-term:
‣ B-blocker/CCB - symptomatic relief
‣ 75mg Aspirin
‣ Statin
➌ No improvement despite 2 doses of GTN - may indicate ACS
➍ Have pt take all 3 medications
➎ Revasularisation - CABG or PCI w/stenting
→ • Symptoms not well controlled despite optimal medical management + extensive disease/stenosis
N.B. PCI is more cost-effective, but CABG has a better mortality risk for those with more severe disease
