Stable Angina

Question 1

Definition

Answer 1

Occlusion of the Coronary arteries which leads to educed blood flow and therefore supply of 02 and nutrients to the the myocardium.
Associated with Ischaemia rather necrosis.

Question 2

How to differentiate between stable and non-stable angina

Answer 2

Stable angina is associated with exercise

Non stable angina occurs at rest as well

Question 3

Causes

Answer 3

1- CORONARY ARTERY ATHEROSCLEROSIS: over 70% occlusion
2-hypertrophy- increases metabolic demands
3-aortic stenosis- increases metabolic demands as pumping against higher pressures
4-hypertension- increased metabolic demand due to pumping against higher pressures
5-Anaemia- reduced 02 transport
6-coronary artery spasm
7-coronary artery inflammation

Question 4

Investigations

Answer 4

Blood count 
Lipid profile 
Kidney tests
ECG: 
-normal in 50% of cases 
-may show hypertrophy
ETT:
-relies on ability to walk long enough to produce stress
-ST depression
-if test negative at high stress then good prognosis
MYOCARDIAL PERFUSION IMAGING
-Better than ETT at detecting CAD, size of affected area 
-inject radionuclide 
-2 images: on at rest, one on exertion 
-If seen only at rest- ischaemia
-if seen in neither- infarction 
CT CORONARY ANGIOGRAPHY:
-very expensive 
-if ETT signs show positive indication 
-in young adults and people with occupational hazards who have unconfirmed tests
CARDIAC CATHERISATION:
-cannula inserted into femoral or radius
-into aortic root
-into ostium of CA
-radio-opaque dye
-good to determine treatment plan

Question 5

Symptoms

Answer 5

-chest pain:
tightness
radiating up left arm, jaw and neck
retro-sternal

in some cases can present with no chest pain:
in elderly, diabetic patients, reduced pain sensation patients
-syncope
-fatigue
-SOB

Question 6

Explain chest pain

Answer 6

• sub-endothelium ischaemia- due to hypertrophy
• release of adenosine, bradykinin
• lead to chest pain

Question 7

signs

Answer 7

-Tar stains
-Corneus archus
-Xanthalasma
-Signs of cardiac failure
In systemic:peripheral oedema, increased JVP,weak/absent peripheral pulses
In pulmonary: crackles of pleural effusion
-pansystolic murmur of mitral regurgitation
-plateau murmur of aortic stenosis
-pallor of anaemia

Triggering factors: exercise
Relieving factors: GTN spray, stop exercise

Question 8

Treatment

Answer 8

1-address life style factors: BP, cholesterol, diet
2-Medication for treatment:
-aspirin: protects endothelium lining, clopidogrel if intolerant
-ACE inhibitors: reduces chances of plaque rupturing
-statins: if cholesterol is over 3.5 mmol/l,reduces deposition of LDLs into atheromas, reduces chances of plaque rupturing
3-Relieving symptom medication : used to achieve HR<60bpm
-calcium channel blockers
-nitrates
-Ivabridine
4-Surgery:
-CABG
-percutaneous coronary intervention

Question 9

PCI

Answer 9

• cross stenotic lesion with guide wire and squash plaque into wall and stent
• aspirin taken during operation so stent not recognised as foreign
• good for symptom relief but no significant indication it improves chances of stable disease

Question 10

CABG-

Answer 10

• uses saphenous vein as graft
• in patients with over 70% occlusion of coronary artery
• 3 occluded vessels proximal to the heart

Question 11

Risk factors

Answer 11

• hypertension
• smoker
• male
• post-menopausal female
• hyperlipidemia
• hypeglycemia
• diabetic