Stable angina Flashcards
Name 5 risk factors for Coronary artery disease
Non-modifiable:
- Increasing age
- Male
- Genetics
- FHx
- Ethnicity
Modifiable:
- Smoking
- Hyperlipidaemia
- HTN
- Obesity and sedentary lifestyle
- Excessive alcohol
- Diabetes mellitus
- Gout
What tool is used to identify cardiovascular risk? When should treatment be started to prevent CV disease?
QRISK2 risk assessment
Atorvastatin 20mg if 10yr-CV risk 10%+
Atorvastatin 80mg if established CV disease
Suggest five preventative measures for cardiovascular disease
Lifestyle:
- Low fat diet (<30% total kcal)
- Low cholesterol intake (<300mg/d)
- 5 fruit/veg a day
- Exercise at least 150 min (moderate) or 75 min (intense)
- BMI <25
- Smoking cessation
Medical:
- HTN control
- DM control
- Atorvastatin if 10yr-CV risk 10%+
Define Angina pectoris
Chest pain due to coronary artery disease that occurs on physical exertion or stress and is relieved by rest.
Describe the characteristics of Classical angina
- Chest pain is typically heavy, tight, or griping
- Central/retrosternal
- May radiate to jaw and/or arms
Outline the functional classification of angina
Class I: No angina with ordinary activity. Angina with strenuous activity.
Class II: Angina with ordinary activity, with mild limitation of activities.
Class III: Angina with low levels of activity, with marked restriction of activities.
Class IV: Angina at rest or with any level of exercise.
Define unstable angina
- Angina of recent onset (<24h) or;
- Deterioration in previous stable angina
- Symptoms occurring at rest.
Suggest three initial laboratory investigations for stable angina
- FBC: exclude anaemia
- TFT: hyperthyroid increases work of heart; hypothyroid associated with hypercholesterol
- Fasting glucose, HbA1c: co-morbid DM
- Fasting lipid
- U+E
- LFTs: statins can cause abnormal AST/ALT
- Troponin if unstable
Suggest two bedside investigations used in stable angina?
- 12-lead ECG: exclude ACS, pathological Q waves, LVH, LBBB
- ECHO: Regional wall abnormalities, LV ejection fraction, diastolic function
- Ambulatory ECG (Holter monitoring): Paroxysmal AF, Prinzmetal (vasospastic) angina
What radiological investigation is useful in stable angina?
CXR: Atypical angina, pulmonary disease, heart failure
CT coronary angiography
Outline the initial management of stable angina
- Reassurance (mortality <2% annually)
- Lifestyle modifications:
- Smoking cessation, diet, exercise
- Short-acting nitrate
- Secondary prevention:
- Aspirin 75mg daily
- ACEi if diabetic
- Atorvastatin
- Hypertensive treatment
What side effects may occur with short-acting nitrates? What advice should be given regarding its use?
Flushing, headaches, and light-headedness Advise to repeat dose after 5 minutes if pain remains. Call an emergency ambulance if pain has not gone 5 minutes after taking a second dose.
Outline what anti-anginal drug treatment is available
Beta blocker or CCB as first-line treatment for angina If one not tolerated/contraindicated, consider: Switching to the other option Using a combination of the two If both not tolerated/contraindicated, consider one of the following: Long-acting nitrate Ivabradine: Inhibits funny current in SA node Nicorandil: Peripheral and coronary vasodilatation Ranolazine: Inhibits late Na channels in cardiac cells
What is the indication for invasive intervention in stable angina? What surgical options exist?
Revascularisation is indicated if symptoms are not satisfactorily controlled with optimal medical treatment (two anti-anginal medications). Percutaneous coronary intervention (PCI): Used if single vessel disease, multi-vessel disease <65yr, with suitable anatomy. Coronary artery bypass graft (CABG): Used if unsuitable anatomy for PCI, multi-vessel disease >65yr, diabetes.
Name 3 vessels used in coronary artery bypass
Left internal mammary artery: Best long-term result Radial artery: Must perform Allen test Long saphenous vein: Ease to harvest *Arterial grafts are better and more durable than veins
