Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology > stable angina > Flashcards

stable angina Flashcards

1
Q

what is the biggest cause of stable angina?

A

atherosclerosis of the coronary arteries - in stable angina it is a stable plaque that causes a reduction in blood flow –> ischaemia (not infarction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

why is angina a symptom of ischaemic heart disease?

A

atherosclerosis causes a mismatch between the oxygen demand and oxygen supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the different reasons for oxygen and supply mismatch?

A
  1. impairment of blood flow due to stenosis
  2. increased distal resistance to blood flow due to left ventricular hypertrophy
  3. reduced oxygen carrying capacity of the blood due to anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what does Poiseuille’s law state?

A

the flow of blood is proportional to the fourth power of the radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what diameter do the coronary arteries have to reduce by before sb gets symptoms?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the name given to the body’s control of flow despite varying BP?

A

myogenic control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

explain the physiology and pathophysiology behind stable angina

A

normally:
- the resistance of the epicardial vessels is low
- the resistance of the microvasculature is moderate, so blood flow is determined by the resistance (tone) of the microvascular vessels
- under exercise, more flow is needed so the microvascular resistance falls so that flow can increase
in disease:
- the atherosclerosis in the epicardial arteries causes the resistance in the epicardial arteries to increase, so at rest a diseased person will have to dilate their microvascular vessels
- during exercise the microvasculature has to dilate even more and it cannot do this enough so flow cannot meet metabolic demand –> ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is prinzmental’s angina caused by?

A

pain due to coronary artery spasm, leading to reduce blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is syndrome X (microvascular angina) due to?

A

the microvessels are narrowed and this leads to an increase in resistance of these vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the non-modifiable risk factors for stable angina?

A

Gender
Family history
Personal history
Age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the modifiable risk factors for stable angina?

A 
Smoking
Diabetes
Hypertension
Hypercholesterolaemia
Sedentary lifestyle
‘Stress’
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what factors may precipitate an decreased supply of oxygen?

A 
Anemia
Hypoxemia
Polycythemia
Hypothermia
Hypovolaemia
Hypervolaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what factors increase the demand for oxygen?

A 
Hypertension
Tachyarrhythmia
Valvular heart disease
Hyperthyroidism
Hypertrophic cardiomyopathy
cold weather
heavy meals
emotional stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how does angina present?

A

chest pain
heavy central tight radiation to arms, jaw, neck
precipitated by exertion
relieved by GTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what do the letters stand for in socrates?

A 
Site
Onset
Character 
Radiation 
Associated symptoms 
Time/duration 
Exacerbating/relieving factors 
Severity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the differential diagnoses of chest pain?

A 
Pericarditis/ myocarditis
Pulmonary embolism/ pleurisy
Chest infection/ pleurisy
Dissection of the aorta
Gastro-esophageal (reflux, spasm, ulceration)
Musculo-skeletal
Psychological
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what can be found on medical examination of the pt?

A

often normal
signs of risk factors
signs of complications (midline sternotomy, legs, pacemaker)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is Levine’s sign?

A

when the pt clenches their fist against their chest to describe their angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what investigations are done for stable angina and what are found?

A
  1. ECG - often normal or could be signs of previous MI, eg Q waves, T wave inversion, BBB
  2. echo - normal or again signs of previous infarcts, done to check LV function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what factors does pre-test probability for CAD take into account?

A

gender
age
typicality of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what should be done with the group who have low pre-test probability?

A
  • investigate other causes

- consider other types of coronary disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what should be done with the intermediate risk group after pre-test probability?

A

non-invasive testing for diagnostic purposes

23
Q

What should be done for pts with a high pre-test probability?

A

proceed to risk stratification, offer invasive coronary angiography in pts with severe symptoms

24
Q

what do anatomical tests tell you?

A

whether there are any anatomical narrowings

25
Q

what are the physiological tests telling you?

A

whether there is any ischaemia

26
Q

give examples of two anatomical tests

A

CT angiography

invasive angiography

27
Q

give examples of physiological tests?

A

exercise stress treadmill
stress echo
SPECT (nuclear perfusion)
perfusion (stress) MRI

28
Q

what are we looking for on the treadmill test?

A

ST depression - indicates ischaemia

29
Q

who can’t have a treadmill test?

A

people who can’t walk
people who are very unfit
BBB
young females

30
Q

what does low PPV mean?

A

there are a lot of false positives

31
Q

what does high NPV mean?

A

if the test is negative, then it is highly likely that the pt hasn’t got the problem

32
Q

what happens in the SPECT/myoview scan?

A

radiolabelled tracer is taken up by metabolising tissues and the first scan is done under stress with adenosine and if there is no perfusion defect then the scan is normal, so no need tot repeat the scan, if the first scan is abnormal, bring the pt back for a rest scan and if tis a fixed defect then it is a scar and if it is a reversible defect the nit is ischaemia

33
Q

what does which test the patient receive depend on?

A 
Pre-test probability of CAD
Invasive or non-invasive
Allergies and intolerances
Sensitivity and specificity
PPV and NPV
Radiation
Local expertise
Patient choice
34
Q

what is primary prevention of a major CV event?

A 
risk factor modification
risk assessment tools eg SCORE and QRISK2
antihypertensives 
statins 
diabetic therapy 
smoking cessation
general diet advice 
exercise advice
35
Q

what is the secondary prevention strategy of cardiac arrests?

A
  1. risk factor modulation
  2. drugs to reduce symptoms AND drugs to reduce events
  3. interventions eg PCI or CABG
36
Q

what is the first line anti-anginal?

A

beta blockers

37
Q

which beta blockers are beta 1 ‘specific’?

A

bisoprolol and atenolol

38
Q

what is the effect of beta blockers?

A 
reduce heart rate (-vely chronotropic) - NB chrono means time 
reduce contractility  (negatively ionotropic)
39
Q

what is it an advantage to reduce the heart rate with beta blockers?

A

as filling of the heart happens in diastole, so increase time spent in diastole, so increase flow to myocardium

40
Q

what are the side effects of beta blockers?

A 
Tiredness,
nightmares
Bradycardia
Cold hands 
and feet
Erectile 
dysfunction
41
Q

what are the contraindications of beta blockers?

A

severe bronchospasm: asthma
Prinzmetal’s angina
excess bradycardia
severe heart block

42
Q

What do nitrates do?

A

VENOdilators
dilate systemic veins (reduce venous return to the right side of the heart)
so reduce preload on the heart
via the frank-starling mechanism, the work on the heart is reduced
dilates coronary arteries - by antagonising spasm
veNo for Nitrates

43
Q

what do calcium channel antagonists do?

A

ARTEROdilators
dilate the systemic arteries
reduce Afterload
so reduce the energy required to produce the same cardiac output
so reduce the work of the heart and o2 demand
also dilate coronary arteries and antagonise spasm
non-dihydropyridines
are also negatively inotropic

44
Q

how does nicorandil work?

A

Mixed veno- and artero-dilatory properties

45
Q

how does aspirin work?

A

Cyclo-oxygenase inhibitor
↓ prostaglandin synthesis, incl. thromboxane
↓ platelet aggregation, antipyretic, anti-inflammatory, analgesic – reduce thrombus formation in the coronary arteries

46
Q

How do statins work?

A

reduce cardiac EVENTS (rather than symptoms)
HMGCoA reductase inhibitors
reduce LDL cholesterol, and also stabilises plaques (as well as plaque regression, direct vasodilation, anti-thrombotic, anti-inflammatory)

47
Q

what are the advantages of PCI over CABG?

A

Less invasive
Convenient
Repeatable
Acceptable

48
Q

what are the disadvantages of PCI compared with CABG?

A

Risk stent thrombosis
Risk restenosis
Can’t deal with complex disease
Dual antiplatelet therapy

49
Q

what are the advantages of CABG?

A

better prognosis

deals with complex disease

50
Q

what are the disadvantages of CABG?

A 
Invasive
Risk of stroke, bleeding
Can’t do if frail, comorbid
One time treatment
Length of stay in hosptial is longer 
Time for recovery
51
Q

is CABG used in STEMI?

A

no - bypass is not used in acute pts

52
Q

When is CABG most used?

A

stable angina

53
Q

Is PCI suitable for STEMI, NSTEMI and stable angina?

A

yes

54
Q

what are the complications of stable angina?

A

ACS (stable plaque becoming an unstable one)
CCF
Conduction disease
Arrhythmia

Cardiology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions