Stable Angina Flashcards
Define angina
A discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis
Describe what happens in terms of oxygen which can lead to angina.
Mismatch between supply of O2 and metabolites to myocardium and the myocardial demand for them
What is the most common cause of angina?
Coronary atheroma
-> A reduction in coronary artery blood flow to the myocardium
What can cause a reduction in coronary artery blood flow to the myocardium?
Obstructive coronary atheroma (Very common)
Spasm of a portion of coronary artery (Uncommon)
Abnormal coronary flow (Uncommon).
What condition is the pathology behind angina?
Sorry i worder that badly
Pathology- myocardial ischaemia
Symptoms- angina
What happens when BP and HR increase?
Myocardial oxygen demand increases
Give some examples of situations where HR and BP might increase and, in turn, increase the myocardial oxygen demand?
Exercise, anxiety/emotional stress and after a large meal.
Which factors help to produce angina symtoms?
Exertion, cold weather, emotional stress, following heavy meal.
Where is the pain distribution in stable angina?
Over the chest but can radiate down the left arm (or both)
What % of obstruction must there be in the lumen to produce angina symptoms?
70%
In terms of clinically, how can you differentiate angina pain and other types of pain?
Taking a good history and asking all the pain related questions to get a better understanding
Where is the site of pain in angina?
Retrosternal (pain inside the chest)
What is the character of angina pain?
Described often tight band/pressure/heaviness.
What is the radiation of the pain like in angina?
Might radiate into neck and/or into jaw, down arms.
What are some of the aggravating factors of angina?
Exertion
Emotional stress
What are some of the relieving factors of angina?
Rapid improvement with GTN or physical rest.
Describe pain which is unlikely to be angina.
Sharp/‘stabbing’ pain; pleuritic or pericardial.
Worse on deep inspiration
Pinpointed to certain location
It’s important to consider differential diagnosis’ when looking at chest pain as it isn’t always angina/myocardial ischaemia.
What are some other cardiovascular conditions which can cause chest pain?
Aortic dissection (intra-scapular “tearing”), pericarditis
What are some respiratory conditions which can cause chest pain?
Pneumonia, pleurisy, peripheral pulmonary emboli (pleuritic)
What are some musculoskeletal conditions which can cause chest pain?
Cervical disease, costochondritis, muscle spasm or strain
What are some GI conditions which can cause chest pain?
Gastro-oesphageal reflux, oesophageal spasm, peptic ulceration, biliary colic, cholecystitis, pancreatitis
What can be used to define the severity of suspected myocardial ischaemia/angina?
CCS- Canadian Classification of Angina Severity
What does a CCS classification of 1 mean?
Ordinary physical activity does not cause angina, symptoms only on significant exertion.
What does a CCS classification of 2 mean?
Slight limitation of ordinary activity, symptoms on walking 2 blocks or > 1 flight of stairs.
What does a CCS classification of 3 mean?
Marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs.
What does a CCS classification of 4 mean?
Symptoms on any activity, getting washed/dressed causes symptoms.