Stable angina Flashcards
What causes angina?
Angina is caused by atherosclerosis affecting the coronary arteries, narrowing the lumen and reducing blood flow to the myocardium. During high-demand times, insufficient blood flow causes symptoms, typically constricting chest pain.
What is stable angina?
Stable angina occurs when symptoms appear only with exertion and are always relieved by rest or glyceryl trinitrate (GTN).
What is unstable angina?
Unstable angina occurs when symptoms appear randomly, even at rest. It is a type of acute coronary syndrome (ACS) and requires immediate management.
What baseline investigations should be done for patients with angina?
Baseline investigations include:
* Physical examination (heart sounds, signs of heart failure, BP, BMI)
* ECG
* FBC (for anaemia)
* U&Es (before starting ACE inhibitors)
* LFTs (before starting statins)
* Lipid profile
* Thyroid function tests
* HbA1C and fasting glucose (for diabetes)
What is cardiac stress testing?
Cardiac stress testing assesses heart function during exertion, using exercise or medication (e.g., dobutamine). The test can include an ECG, echocardiogram, MRI, or myocardial perfusion scan.
What is CT coronary angiography?
CT coronary angiography uses contrast and CT imaging timed with heart contractions to visualize coronary arteries and highlight areas of narrowing.
What is invasive coronary angiography?
Invasive coronary angiography is performed in a catheter lab where a catheter is inserted into the artery and guided to the coronary arteries. Contrast is injected, and x-rays are taken to visualize stenosis.
What are the five principles of angina management?
The ‘RAMPS’ mnemonic for managing angina:
* R – Refer to cardiology
* A – Advise on diagnosis, management, and when to call an ambulance
* M – Medical treatment
* P – Procedural or surgical interventions
* S – Secondary prevention
What is the aim of medical management for angina?
The aims of medical management are:
* Immediate symptomatic relief during angina episodes
* Long-term symptomatic relief
* Secondary prevention of cardiovascular disease
How is immediate symptomatic relief provided during angina episodes?
Immediate relief is provided with sublingual glyceryl trinitrate (GTN), which causes vasodilation to improve blood flow to the myocardium.
What should a patient do when experiencing angina and using GTN?
Patients should:
* Take GTN when symptoms start
* Take a second dose after 5 minutes if symptoms persist
* Call an ambulance if symptoms last 5 minutes after the second dose
What are the side effects of glyceryl trinitrate (GTN)?
Key side effects of GTN include headaches and dizziness caused by vasodilation.
What are first-line medications for long-term symptomatic relief in angina?
First-line medications include:
* Beta blockers (e.g., bisoprolol)
* Calcium-channel blockers (e.g., diltiazem, verapamil - avoided in heart failure with reduced ejection fraction)
What are other options for long-term symptomatic relief in angina?
Other options include:
* Long-acting nitrates (e.g., isosorbide mononitrate)
* Ivabradine
* Nicorandil
* Ranolazine
What medications are used for secondary prevention in angina?
The ‘four As’ mnemonic for secondary prevention:
* A – Aspirin 75mg daily
* A – Atorvastatin 80mg daily
* A – ACE inhibitor (if diabetes, hypertension, CKD, or heart failure)
* A – Already on a beta blocker for symptomatic relief
What are the two surgical interventions for severe angina?
The two surgical interventions are:
* Percutaneous coronary intervention (PCI)
* Coronary artery bypass graft (CABG)
What is percutaneous coronary intervention (PCI)?
PCI involves inserting a catheter into the artery to inject contrast and visualize coronary stenosis. Treatment involves balloon angioplasty to widen the artery and inserting a stent to keep it open.
What is coronary artery bypass graft (CABG) surgery?
CABG involves surgically bypassing stenotic coronary arteries by grafting a vessel (saphenous vein, internal thoracic artery, or radial artery) to restore blood flow.
What are the advantages and disadvantages of PCI compared to CABG?
Advantages and disadvantages include:
* PCI has a faster recovery and lower rate of strokes, but a higher rate of needing repeat procedures.
* CABG is more invasive but can be more effective in severe cases with multiple blockages.
What should you check when examining a patient with suspected coronary artery disease (CAD)?
Check for scars indicating previous procedures:
* Midline sternotomy (for CABG)
* Scars around brachial and femoral arteries (for PCI)
* Scars along inner calves (saphenous vein harvesting for CABG)
