Stable Angina Flashcards
define stable angina
a discomfort in the chest and/or adjacent areas associated with myocardial ischemia but without myocardial necrosis
what causes this pain?
a mismatch between supply of O2 and metabolites to myocardium and myocardial demand for them
name three things that would result in a reduction in coronary blood flow to the myocardium
> obstructive coronary atheroma
coronary artery spasm
coronary inflammation/arteritis
what is an uncommon cause of angina that pathologically increases myocardial O2 demand?
> left ventricular hypertrophy
> thyrotoxicosis
why do symptoms of angina occur on activity?
there is an increase in myocardial oxygen demand but the obstructed coronary blood flow leads to myocardial ischemia and then symptoms of angina
what would an obstructive plaque >70% of the lumen cause?
stable angina
what characteristic will pain have?
Site = retrosternal Character = tight band Radiation = neck, jaw, down the arms Aggravating = exertion, emotion Relieving Factors = rapid improvement with GTN or physical rest
name some features that make angina less likely
> sharp/stabbing pleuritic pain > associated with body movement > localised > superficial > no pattern to onset > beginning some time after exercise > lasting for hours
what is the differential diagnosis for chest pain?
> cardiovascular disease
respiratory
musculoskeletal
GI causes
stable angina can sometimes present with no chest pain but other symptoms on exertion such as…….?
> breathlessness
excessive fatigue
near syncope
in what people may pain not be a symptom?
the elderly or those with diabetes mellitus
what is number one on the CCS scale?
ordinary physical activity does not cause angina, symptoms are only on significant exertion
what is number 2 on the CCS scale?
there is slight limitation of ordinary activity, symptoms are on walking more than 1 flight of stairs
what is number three on the CCS?
there is marked limitation and symptoms are on walking up 1 flight of stairs
what is number three on the ccs?
symptoms on any activity, getting washed/dressed
name some non-modifiable risk factors for coronary heart disease
> age
gender
race
family history/genetics
name some modifiable risk factors for coronary heart disease
> smoking > lifestyle > diabetes mellitus > hypertension > hyperlipidaemia
what should you look for on general examination with stable angina?
> tar stains
obesity
xanthalasma and corneal arcus (hypercholseterolaemia)
hypertension
abdominal aortic aneurysm arterial bruits: absent/reduced peripheral pulses
diabetic retinopathy
name some signs of associated conditions
> pallor: anaemia
tachycardia, tremor, hyper-reflexia: hyperthyroidism
ejection diastolic murmur: aortic stenosis
pansystolic murmur: mitral regurgitation#
basal crackles, elevated JVP, peripheral oedema: heart failure
what investigations should be carried out?
> bloods > chest x-ray > electrocardiogram > exercise tolerance test > myocardial perfusion imaging > computer tomography coronary angiography > invasive angiography > cardiac catherterisation
what blood tests are carried out in investigation of angina?
> full blood count > lipid profile > fasting glucose > electrolytes > liver and thyroid
what may an electrocardiogram give evidence of?
> prior myocardial infarction
> left ventricular hypertrophy
what would indicate a positive result in an exercise tolerance test?
typical symptoms and a st-segment depression
describe how a myocardial perfusion imaging test is carried out
radionuclide tracer injected at peak stress and then again at rest. the two images are compared. the normal myocardium takes up the tracer
