Stable Angina Flashcards
what is angina pectoris?
pain of the chest
what is angina?
Common name of angina pectoris, it is discomfrot in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis
in angina is the necrosis of heart tissue?
no
what are the two general causes of angina?
-interruption of blood flow-inadequate blood flow
what is the most common cause of angina?
obstructive coronary atheroma
what is an uncommon cause of angina?
coronary artery spasm
what is a very rare cause of angina?
coronary inflammation (arteritis)
can anaemia cause angina? if so why?
yes, as there is less transport of oxygen to the heart causing ischaemia
what pathological conditions increase the hearts demand for oxygen so have the capacity to cause angina?
left ventricular hypertrophythyrotoxicosis (hyperthyroidism)
what can cause left ventricular hypertrophy?
persistent hypertensionsignificant aortic stenosishypertrophic cardiomyopathy
what is stable angina?
angina pectoris, a predictable pattern of chest pain
in what situations is stable angina most common?
where HR and BP rise as there is greater myocardial oxygen demand.eg. exercise, anxiety, cold weather, emotional stress, after a large meal
a patient comes in with chest pain after running 2 miles . they have had this for many months. how much concern should be raised at this situation?
not a high amount as it is a stable history and most likely to be stable angina
a patient comes in with chest pain after running 2 miles and getting chest pain. they are usually able to run 5 before getting pain, does this warrant much concern?
yes, as the history is unstable and so is unlikely to be stable angina
when obstruction of a coronary artery reaches what percentage does stable angina occur?
> 70% of lumen obstructed
what are the symptoms of stable angina to look out for?
-retrosternal pain-tight band/ pressure heaviness-radiation to neck, jaw and down arms-exacerbated by exertion and emotional stress-relieved by physical rest-rapidly relived by GTN
where is pain from stable angina felt?
retrosternally
what is the character of stable angina pain?
tight band, pressure, heaviness
where does stable angina pain radiate to?
neck, jaw, arms
what relieves stable angina?
physical rest, GTN spray
if chest pain is sharp and stabbing is it likely to be stable angina?
no
if chest pain is pleuritic or pericardial is it likely to be stable angina?
no
if chest pain is associated with body movements, eg leaning forward improves pain and leaning back makes it worse, is it likely to be stable angina?
no
if pain is very localised and patient is able to pinpoint it is it likely to be angina?
no
if pain is superficial and tender is it likely to be stable angina?
no
if pain is superficial and without tenderness is it likely to be stable angina?
no
if chest pain is at rest is it likely to be stable angina?
no
if chest pain has no pattern is it likely to be angina?
no
if chest pain begins after exercise is it likely to be angina?
no
if chest pain last for hours at a time is it likely to be angina?
no
what are the cardiovascular conditions that must be excluded in the differential diagnosis of stable angina?
aortic dissection, pericarditis
what are the respiratory conditions that must be excluded in the differential diagnosis of stable angina?
pneumonia, pleurisy, peripheral pulmonary emboli
what are the muscularskeletal conditions that must be excluded in the differential diagnosis of stable angina?
cervical disease, costochrondritis, muscle spasm or strain
what are the GI conditions that must be excluded in the differential diagnosis of stable angina?
gastro-oesophageal reflux, oesophageal spasm, peptic ulceration, biliary colic, cholecystitis, pancreatitis
what is oesophageal spasm?
contractions of the esophagus are irregular, uncoordinated, and sometimes powerful.
what are peptic ulcers?
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine.
what is biliary colic?
when pain occurs due to a gallstone temporarily blocking the bile duct
what is cholecystitis?
inflammation of the gall bladder
what are the other symptoms of stable angina on exertion that are not chest pain?
-breathless-excessive fatigue-near syncope
which patients with stable angina are more likely not to experience chest pain?
elderlyor sufferers of diabetes mellitus
what is stage 0 of the canadian classification of angina ?
no angina
what is stage I of the Canadian classification of angina severity?
ordinary physical activity does not cause angina, symptoms only on significant exertion
what is stage II of the Canadian classification of angina severity?
Slight limitation of ordinary activity, symptoms on walking 2 blocks or > 1 flight of stairs.
what is stage III of the Canadian classification of angina severity?
Marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs
what is stage IV of the Canadian classification of angina severity?
Symptoms on any activity, getting washed/dressed causes symptoms.
what are the non-modifiable risk factors for stable angina?
Age, gender, race, family history & genetic factors
what are the modifiable risk factors for angina?
SmokingLifestyle- exercise & dietDiabetes mellitus Hypertension Hyperlipidaemia
what factors will be found on examination of a patient with stable angina?
Tar stains on fingers Obesity (centripedal)Xanthalasma and corneal arcus (hypercholesterolaemia)Hypertension,Abdominal aortic aneurysmarterial bruits, absent or reduced peripheral pulses. Diabetic retinopathy, hypertensive retinopathy on fundoscopy.
what are the associated conditions that exacerbate angina?
anaemiahyperthyroidismaortic stenosismitral regurgitationheart failure
what is the main sign of anaemia?
pallor
what are the signs of hyperthyroidism?
tachycardia, tremor, hyper-reflexia ( autonomic nervous system overreacts to external or bodily stimuli)
what are the signs of aortic stenosis?
ejection systolic murmur, plateau pulse
what are the signs of mitral regurgitation?
pansystolic murmur
what are the signs of heart failure?
basal crackleselevated JVPperipheral oedema
what are the investigations for stable angina?
bloods (FBC, lipid profile, fasting glucose, electrolytes, liver test, thyroid test)CXRECGexercise tolerance testingmyocardial perfusion imaging CT coronary angiography
what blood tests are carried out if angina is suspected?
FBClipid profilefasting glucoseelectrolytesliver testthyroid test
why is a CXR carried out if angina is suspected?
shows other causes of chest painshows pulmonary oedema
in what percentage of angina cases is ECG normal?
> 50%
what should be looked out for to diagnose angina from am ECG?
- pathological Q waves- prior myocardial infarction- lateral ST-segment depression or “strain pattern”- LVH
how is angina diagnosed from exercise tolerance testing?
patient placed on dreadmill and exertion increased. ECG is fitted, typical symptoms and ST-segment depression for positive test
what is myocardial perfusion imaging used to determine in angina?
localisation of ischaemiaassessing size of area affected
in myocardial perfusion imaging if the tracer is seen during rest but not in stress what does this suggest?
ischaemia
in myocardial imaging if the tracer is not seen during stress or after stress what does this suggest?
infarction
when are invasive angiography techniques used for angina?
-early or strongly positive ETT-angina refactory to medical therapy-diagnosis not clear after non-invasive tests-young cardiac patients due to work/life effects-occupation or lifestyle with risk
how are cardiac catheters inserted for coronary angiography?
- done under local anaesthetic2. arterial cannula inserted into femoral or radial artery3. coronary catheters passed to aortic root and introduced into the ostium of coronary arteries4. radio-opaque contrast injected down coronary arteries
what the general measures taken to treat angina?
treat: BP, diabetes mellitis, cholesterol, lifestyle
if symptoms of angina are not controlled what other treatments are available?
percutaneous coronary intervention and coronary bypass grafting
when are statins used to treat angina?
when there is hypercholesterolaemia, >3.5mmol/L
what is the action of statins in angina?
reduce cholesterol levels, this stabilises atheroma and prevents plaque rupture causing acute coronary syndrome
when are ACE inhibitors used for angina?
if there is increased cardiovascular risk and atheroma
why is aspirin used to treat angina?
-does not affect plaque -protects endothelium of vessels -reduced platelet activation/ aggregation
which medications are used to prevent the progression of angina?
statinsACE inhibitorsAspirin
which medicines are used for relief of symptoms of angina?
B-blockersCa2+ channel blockersIk channel blockersnitratesk+channel blockers
what is the percutaneous coronary intervention used to treat angina?
percutaneous transluminal coronary agioplasty and stenting
describe the process of percutaneous transluminal coronary agioplasty and stenting?
coronary catheter inserted through femoral or radial artery and the atheromatous plaque is squashed into walls if vessel with balloon and stent
what medication is used when a stent is placed in the coronary artery?
aspirin and clopidogrel
does percutaneous coronary intervention improve the prognosis of angina patients?
no
which groups of people receive prognostic benefit from coronary artery bypass surgery?
->70% stenosis of left main stem artery -significant proximal 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 < 50%.
