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Cardiovascular system > stable angina > Flashcards

stable angina Flashcards

1
Q

what is angina pectoris?

A

pain of the chest

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2
Q

what is angina?

A

Common name of angina pectoris, it is discomfrot in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis

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3
Q

in angina is the necrosis of heart tissue?

A

no

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4
Q

what are the two general causes of angina?

A
  • interruption of blood flow

- inadequate blood flow

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5
Q

what is the most common cause of angina?

A

obstructive coronary atheroma

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6
Q

what is an uncommon cause of angina?

A

coronary artery spasm

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7
Q

what is a very rare cause of angina?

A

coronary inflammation (arteritis)

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8
Q

can anaemia cause angina? if so why?

A

yes, as there is less transport of oxygen to the heart causing ischaemia

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9
Q

what pathological conditions increase the hearts demand for oxygen so have the capacity to cause angina?

A

left ventricular hypertrophy

thyrotoxicosis (hyperthyroidism)

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10
Q

what can cause left ventricular hypertrophy?

A

persistent hypertension
significant aortic stenosis
hypertrophic cardiomyopathy

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11
Q

what is stable angina?

A

angina pectoris, a predictable pattern of chest pain

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12
Q

in what situations is stable angina most common?

A

where HR and BP rise as there is greater myocardial oxygen demand.
eg. exercise, anxiety, cold weather, emotional stress, after a large meal

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13
Q

a patient comes in with chest pain after running 2 miles . they have had this for many months. how much concern should be raised at this situation?

A

not a high amount as it is a stable history and most likely to be stable angina

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14
Q

a patient comes in with chest pain after running 2 miles and getting chest pain. they are usually able to run 5 before getting pain, does this warrant much concern?

A

yes, as the history is unstable and so is unlikely to be stable angina

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15
Q

when obstruction of a coronary artery reaches what percentage does stable angina occur?

A

> 70% of lumen obstructed

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16
Q

what are the symptoms of stable angina to look out for?

A
  • retrosternal pain
  • tight band/ pressure heaviness
  • radiation to neck, jaw and down arms
  • exacerbated by exertion and emotional stress
  • relieved by physical rest
  • rapidly relived by GTN
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17
Q

where is pain from stable angina felt?

A

retrosternally

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18
Q

what is the character of stable angina pain?

A

tight band, pressure, heaviness

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19
Q

where does stable angina pain radiate to?

A

neck, jaw, arms

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20
Q

what relieves stable angina?

A

physical rest, GTN spray

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21
Q

if chest pain is sharp and stabbing is it likely to be stable angina?

A

no

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22
Q

if chest pain is pleuritic or pericardial is it likely to be stable angina?

A

no

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23
Q

if chest pain is associated with body movements, eg leaning forward improves pain and leaning back makes it worse, is it likely to be stable angina?

A

no

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24
Q

if pain is very localised and patient is able to pinpoint it is it likely to be angina?

A

no

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25
Q

if pain is superficial and tender is it likely to be stable angina?

A

no

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26
Q

if pain is superficial and without tenderness is it likely to be stable angina?

A

no

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27
Q

if chest pain is at rest is it likely to be stable angina?

A

no

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28
Q

if chest pain has no pattern is it likely to be angina?

A

no

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29
Q

if chest pain begins after exercise is it likely to be angina?

A

no

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30
Q

if chest pain last for hours at a time is it likely to be angina?

A

no

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31
Q

what are the cardiovascular conditions that must be excluded in the differential diagnosis of stable angina?

A

aortic dissection, pericarditis

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32
Q

what are the respiratory conditions that must be excluded in the differential diagnosis of stable angina?

A

pneumonia, pleurisy, peripheral pulmonary emboli

33
Q

what are the muscularskeletal conditions that must be excluded in the differential diagnosis of stable angina?

A

cervical disease, costochrondritis, muscle spasm or strain

34
Q

what are the GI conditions that must be excluded in the differential diagnosis of stable angina?

A

gastro-oesophageal reflux, oesophageal spasm, peptic ulceration, biliary colic, cholecystitis, pancreatitis

35
Q

what is oesophageal spasm?

A

contractions of the esophagus are irregular, uncoordinated, and sometimes powerful.

36
Q

what are peptic ulcers?

A

Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine.

37
Q

what is biliary colic?

A

when pain occurs due to a gallstone temporarily blocking the bile duct

38
Q

what is cholecystitis?

A

inflammation of the gall bladder

39
Q

what are the other symptoms of stable angina on exertion that are not chest pain?

A
  • breathless
  • excessive fatigue
  • near syncope
40
Q

which patients with stable angina are more likely not to experience chest pain?

A

elderly

or sufferers of diabetes mellitus

41
Q

what is stage 0 of the canadian classification of angina ?

A

no angina

42
Q

what is stage I of the Canadian classification of angina severity?

A

ordinary physical activity does not cause angina, symptoms only on significant exertion

43
Q

what is stage II of the Canadian classification of angina severity?

A

Slight limitation of ordinary activity, symptoms on walking 2 blocks or > 1 flight of stairs.

44
Q

what is stage III of the Canadian classification of angina severity?

A

Marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs

45
Q

what is stage IV of the Canadian classification of angina severity?

A

Symptoms on any activity, getting washed/dressed causes symptoms.

46
Q

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

A

Age, gender, race, family history & genetic factors

47
Q

what are the modifiable risk factors for angina?

A 
Smoking
Lifestyle- exercise & diet
Diabetes mellitus   
Hypertension 
Hyperlipidaemia
48
Q

what factors will be found on examination of a patient with stable angina?

A

Tar stains on fingers
Obesity (centripedal)
Xanthalasma and corneal arcus (hypercholesterolaemia)
Hypertension,
Abdominal aortic aneurysm
arterial bruits, absent or reduced peripheral pulses.
Diabetic retinopathy, hypertensive retinopathy on fundoscopy.

49
Q

what are the associated conditions that exacerbate angina?

A 
anaemia
hyperthyroidism
aortic stenosis
mitral regurgitation
heart failure
50
Q

what is the main sign of anaemia?

A

pallor

51
Q

what are the signs of hyperthyroidism?

A

tachycardia, tremor, hyper-reflexia ( autonomic nervous system overreacts to external or bodily stimuli)

52
Q

what are the signs of aortic stenosis?

A

ejection systolic murmur, plateau pulse

53
Q

what are the signs of mitral regurgitation?

A

pansystolic murmur

54
Q

what are the signs of heart failure?

A

basal crackles
elevated JVP
peripheral oedema

55
Q

what are the investigations for stable angina?

A 
bloods (FBC, lipid profile, fasting glucose, electrolytes, liver test, thyroid test)
CXR
ECG
exercise tolerance testing
myocardial perfusion imaging 
CT coronary angiography
56
Q

what blood tests are carried out if angina is suspected?

A 
FBC
lipid profile
fasting glucose
electrolytes
liver test
thyroid test
57
Q

why is a CXR carried out if angina is suspected?

A

shows other causes of chest pain

shows pulmonary oedema

58
Q

in what percentage of angina cases is ECG normal?

A

> 50%

59
Q

what should be looked out for to diagnose angina from am ECG?

A
  • pathological Q waves- prior myocardial infarction

- lateral ST-segment depression or “strain pattern”- LVH

60
Q

how is angina diagnosed from exercise tolerance testing?

A

patient placed on dreadmill and exertion increased. ECG is fitted, typical symptoms and ST-segment depression for positive test

61
Q

what is myocardial perfusion imaging used to determine in angina?

A

localisation of ischaemia

assessing size of area affected

62
Q

in myocardial perfusion imaging if the tracer is seen during rest but not in stress what does this suggest?

A

ischaemia

63
Q

in myocardial imaging if the tracer is not seen during stress or after stress what does this suggest?

A

infarction

64
Q

when are invasive angiography techniques used for angina?

A
  • early or strongly positive ETT
  • angina refactory to medical therapy
  • diagnosis not clear after non-invasive tests
  • young cardiac patients due to work/life effects
  • occupation or lifestyle with risk
65
Q

how are cardiac catheters inserted for coronary angiography?

A
  1. done under local anaesthetic
  2. arterial cannula inserted into femoral or radial artery
  3. coronary catheters passed to aortic root and introduced into the ostium of coronary arteries
  4. radio-opaque contrast injected down coronary arteries
66
Q

what the general measures taken to treat angina?

A

treat: BP, diabetes mellitis, cholesterol, lifestyle

67
Q

if symptoms of angina are not controlled what other treatments are available?

A

percutaneous coronary intervention and coronary bypass grafting

68
Q

when are statins used to treat angina?

A

when there is hypercholesterolaemia, >3.5mmol/L

69
Q

what is the action of statins in angina?

A

reduce cholesterol levels, this stabilises atheroma and prevents plaque rupture causing acute coronary syndrome

70
Q

when are ACE inhibitors used for angina?

A

if there is increased cardiovascular risk and atheroma

71
Q

why is aspirin used to treat angina?

A
  • does not affect plaque
  • protects endothelium of vessels
  • reduced platelet activation/ aggregation
72
Q

which medications are used to prevent the progression of angina?

A

statins
ACE inhibitors
Aspirin

73
Q

which medicines are used for relief of symptoms of angina?

A 
B-blockers
Ca2+ channel blockers
Ik channel blockers
nitrates
k+channel blockers
74
Q

what is the percutaneous coronary intervention used to treat angina?

A

percutaneous transluminal coronary agioplasty and stenting

75
Q

describe the process of percutaneous transluminal coronary agioplasty and stenting?

A

coronary catheter inserted through femoral or radial artery and the atheromatous plaque is squashed into walls if vessel with balloon and stent

76
Q

what medication is used when a stent is placed in the coronary artery?

A

aspirin and clopidogrel

77
Q

does percutaneous coronary intervention improve the prognosis of angina patients?

A

no

78
Q

which groups of people receive prognostic benefit from coronary artery bypass surgery?

A
  • > 70% stenosis of left main stem artery
  • significant proximal three-vessel coronary artery disease
  • two vessel coronary artery disease that includes significant stenosis of proximal left anterior descending coronary artery and who have ejection fraction < 50%.

Cardiovascular system (40 decks)

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