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Cardiovascular > Stable Angina > Flashcards

Stable Angina Flashcards

1
Q

What is angina?

A

Discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis

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2
Q

Why does angina happen?

A

Mismatch between supply of oxygen and metabolites to the myocardium and the myocardial demand for them

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3
Q

What causes angina?

A

Obstructive coronary atheroma
Coronary artery spasm
Coronary inflammation

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4
Q

What is the most common cause of angina?

A

Obstructive coronary atheroma

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5
Q

What are the very unlikely causes of angina?

A

Reduced oxygen transport

Pathologically increased myocardial oxygen demand

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6
Q

What can cause angina because of reduced oxygen transport?

A

Anaemia

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7
Q

What can cause angina because of increased myocardial oxygen demand?

A

LV hypertrophy

Thyrotoxicosis

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8
Q

Why does hypertrophy cause angina?

A

Because there is more tissue to supply blood to but not enough blood so there is ischaemia which causes pain

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9
Q

What can cause LV hypertrophy?

A

Hypertension
Aortic stenosis
Hypertrophic cardiomyopathy

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10
Q

When does myocardial oxygen demand increase?

A

Increased heart rate

Increased blood pressure

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11
Q

Why does angina happen?

A

Because of myocardial ischaemia

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12
Q

Where is the typical distribution of pain or discomfort with angina?

A

On the left top side of the chest and going down the medial part of the left arm

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13
Q

What is the key characteristic of stable angina?

A

It happens on exertion and goes away after rest

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14
Q

In the blood vessels what causes stable angina?

A

Obstructive plaque that covers 70% or more of the lumen

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15
Q

When there is spontaneous rupture of a plaque and local thrombosis with a degree of occlusion what is this called?

A

Acute coronary syndrome

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16
Q

What is the typical character of pain associated with angina?

A

Tight band
Pressure
Heaviness

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17
Q

Where are the radiation sites for angina pain?

A

Neck
Jaw
Down arms

18
Q

What aggravates stable angina?

A

Exertion

Emotional stress

19
Q

What improves angina rapidly?

A

GTN

Physical rest

20
Q

What characteristics make angina less likely?

A 
Sharp/stabbing pain 
Associated with body movement or respiration 
Very localised 
Superficial 
No pattern to pain 
Often occurring at rest 
Begins after exercise
Last for hours
21
Q

What symptoms can myocardial ischaemia present as without angina?

A

Breathless on exertion
Excessive fatigue on exertion
Near syncope on exertion

22
Q

Who is more likely to present with myocardial ischaemia without angina?

A

Elderly

Diabetes mellitus

23
Q

What are the risk factors for coronary artery disease?

A 
Age 
Gender 
Family history 
Genetic factors 
Smoking 
Lifestyle 
Diabetes mellitus 
Hypertension 
Hyperlipidaemia
24
Q

What should you look for on examination of stable angina?

A 
Tar staining 
Obesity 
Xanthalasma 
Corneal Marcus 
Hypertension 
Abdominal aortic aneurysm atrial bruits, absent or reduced peripheral pulses 
Diabetic retinopathy
25
Q

What are some exacerbating or associated conditions to stable angina?

A 
Anaemia 
Tachycardia 
Aortic stenosis 
Hyperthyroidism 
Mitral regurgitation 
Heart failure
26
Q

What are you looking for in anaemia?

A

Pallor

27
Q

What are you looking for in hyperthyroidism?

A

Tachycardia
Tremor
Hyper-reflexia

28
Q

What are you looking for in aortic stenosis?

A

Ejection systolic murmur

29
Q

What are the signs of heart failure?

A

Basal crackles
Elevated JVP
Peripheral oedema

30
Q

What investigations can be done for stable angina?

A 
Full blood count 
Lipid profile 
Fasting glucose 
Electrolytes 
Liver function tests 
Thyroid function tests
Chest x-ray  
Electrocardiogram 
Exercise tolerance test
Myocardial perfusion imaging 
CT coronary angiography  
Coronary angiography
31
Q

What are the treatment strategies for stable angina?

A

Address risk factors
Drugs to reduce disease progression and symptoms
PCI
CABG

32
Q

What is the medical treatment for disease progression?

A

Statins
ACE inhibitors
Aspirin

33
Q

What affect do statins have?

A

Reduces LDL-cholesterol deposition in atheroma so stabilises them reducing plaque rupture and ACS

34
Q

What affect do ACE inhibitors have?

A

Stabilises endothelium and reduces plaque rupture

35
Q

What affect does Aspirin have?

A

Protects endothelium and reduces platelet activation

36
Q

What is the medical treatment for relief of symptoms?

A 
Beta blockers 
Calcium channel blockers 
Ik channel blockers
Nitrates 
Potassium channel blockers
37
Q

What do calcium channel blockers do?

A

Produce vasodilation

38
Q

What do Nitrates do?

A

Produce vasodilation

39
Q

What do beta blockers do?

A

Reduce myocardial work and have anti-arrhythmic effects

40
Q

What is PCI?

A

Percutaneous coronary intervention such as coronary angioplasty and stenting. Squashes plaque into walls with balloon and stent

41
Q

What is CABG?

A

Coronary artery bypass surgery is often the best option for stable angina but is significantly more risky than PCI

Cardiovascular (34 decks)

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