Stable angina Flashcards
What is stable angina?
It is cardiac chest pain associated with myocardial ischaemia, but not necrosis
What is the physiological cause of stable angina?
Mismatch between the demand and supply of blood to cardiac muscle, most commonly caused by reduction in coronary blood flow
List the causes of stable angina
obstructive coronary atheroma, coronary artery spasm, coronary inflammation (rare), anaemia, left ventricular hypertrophy and increased O2 demand, or thyrotoxicosis with increased metabolic demand
When does the symptoms of stable angina become apparent?
On exertion, big meal, cold weather, stress, anxiety
What narrowing causes stable angina?
Lumen narrowing of 70 % or more
What are the symptoms of stable angina?
retrosternal chest pain, tight band, heaviness, pressure, radiation to left side mainly, arm, jaw, neck, gets worse on stress and exertion, received on rest and GTN
What is the unusual presentation of stable angina?
Dyspnoea on exertion, no pain, excessive fatigue, near syncope, more common in elderly with DM
What is the classification system that is used to assess the severity of angina?
Canadian classification of angina severity CCS
How many stages are there in angina ?
4 stages
What is stage 1 angina ?
Symptoms are present only on significant physical activity
What is stage 2 angina?
Symptoms on walking 2 blocks or more than 1 flight of stairs, slight limitation to ordinary activities
What is stage 3 angina?
Symptoms on walking 1-2 blocks or 1 flight of stairs, marked limitation to ordinary activities
What is stage 4 angina ?
Symptoms on any activity, getting washed, dressed
What are the risk factors for stable angina?
Smoking, hyperlipidaemia, diabetes mellitus, hypertension, exercise and diet, age, gendre, family history, genetic factor
What are the investigations for angina ?
Bloods (FBC, lipid profile, fasting glucose, electrolytes, liver and thyroid tests), chest X ray, ECG, exercise tolerance test, myocardial perfusion imaging, CT coronary angiography, invasiva angiography
What can be observed on ECG on exertion ?
Depression of ST segment due to LVH
What is the treatment of angina ?
Control risk factor by BP, DM, cholesterol medication, lifestyle changes, statins, ACE inhibitors, aspirin or clopidogrel, CCB, ik channel blockers, K+ channel blockers, nitrates, revascularisation, percutaneous transluminal coronary angioplasty and stunting, coronary artery bypass surgery
When should be coronary bypass surgery performed?
When left main coronary artery is occluded more than 70%, three vessels with significant proximal occlusion, two vessels with proximal occlusion of anterior descending and ejection fraction lower than 50%
Which blood vessels can be used for the bypass surgery?
usually long saphenous vein, left internal mammary artery
