Stable Angina Flashcards
What is the definition of angina?
A discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis
What are the most common ways coronary blood flow to the myocardium is reduced?
Obstructive coronary atheroma (Very common)
Coronary artery spasm (Uncommon);
Coronary inflammation/arteritis (Very rare)
What are the uncommon reasons for ahving stable angina?
Uncommonly due to :
- (coronary spasm or artery inflammation)
- Reduced O2 transport (anaemia of any cause)
- Pathological increase in myocardial O2 demand
- Thyrotoxicosis - hypermetabolic state.
What is the effect of coronary atheroma on the onset of excersize?
Increased myocardial oxygen demand leads to myocardial ischaemia because of the obstructed coronary blood flow - symotoms of angina arise
What situations might cause HR and BP to rise (and therefore myocardial oxygen demand)?
Exercise, anxiety/emotional, cold weather, stress and after a large meal.
What is angina felt in the chest called?
Angina pectoris
What level of obstruction is present in the lumen in stable angina?
Obstructive if over 70% of the lumen
How should the patient describe the site of the pain?
Retrosternal
How should the patient describe character of the pain?
often tight band/pressure/heaviness
Where can the pain of angina radiate?
neck and/or into jaw, down arms
What are the releiving factors for angina?
Rest and GTN
When is the pain less likely to be angina?
Sharp/‘stabbing’ pain; pleuritic or pericardial.
Associated with body movements or respiration.
Very localised; pinpoint site.
Superficial with/or without tenderness.
No pattern to pain, particularly if often occuring at rest.
Begins some time after exercise.
Lasting for hours.
What are the differential diagnoses for angina?
Cardiovascular causes:
Aortic dissection (intra-scapular “tearing”), pericarditis
Respiratory:
Pneumonia, pleurisy, peripheral pulmonary emboli (pleuritic)
Musculoskeletal:
Cervical disease, costochondritis, muscle spasm or strain
GI causes:
Gastro-oesphageal reflux, oesophageal spasm, peptic ulceration, biliary colic, cholecystitis, pancreatitis
What is meant by dissection of aorta?
When the inner layer of the aorta tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect).
Myocardial ischaemia can occur without chest pain but other symptoms, what are these symptoms?
Breathlessness on exertion
Excessive fatigue on exertion for activity undertaken
Near syncope on exertion.
More often in the elderly or those with diabetes mellitus: probably due to reduced pain sensation.
What is the canadian classification for angina severity?
- Ordinary physical activity does not cause angina, symptoms only on significant exertion.
- Slight limitation of ordinary activity, symptoms on walking 2 blocks or > 1 flight of stairs.
- Marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs.
- Symptoms on any activity, getting washed/dressed causes symptoms.
What are the non-modifiable risk factors for angina?
Age, gender, creed, family history & genetic factors
What are the modifiable risk factors for angina?
Smoking
Lifestyle - excersize and diet
Diabetes mellitus - glycaemic control reduces CV risk
Hypertension - BP control reduces CV risk
Hyperlipidaemia - lowering reduces CV risk
What are typical signs of people with angina?
Tar stains on fingers
Obesity (centripedal(high waist to hip ratio (apple shape)))
Xanthalasma and corneal arcus (cholesterol deposit in the iris) (hypercholesterolaemia)
Hypertension,
Abdominal aortic aneurysm arterial bruits, absent or reduced peripheral pulses.
Diabetic retinopathy, hypertensive retinopathy on fundoscopy.
What are the exacerbating or associated conditions?
Pallor of anaemia
Tachycardia, tremor, hyper-reflexia of hyperthyroidism (overactive reflexes)
Ejection systolic murmur, plateau pulse of aortic stenosis
Pansystolic murmur of mitral regurgitation, and
Signs of heart failure such as basal crackles, elevated JVP, peripheral oedema.
