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Stable Angina Flashcards

1
Q

What is angina pectoris?

A

Chest pain

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2
Q

What is myocardial ischaemia?

A

A mismatch in the supply of O2 and metabolite to the myocardium and the demand of for them

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3
Q

What are the two general causes for myocardial ischaemia?

A

Interruption of blood flow

Inadequate blood flow

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4
Q

What is a common cause of angina?

A

Obstructive coronary atheroma

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5
Q

What are two uncommon causes?

A 
Coronary artery spasm 
Coronary inflammation (arteritis)
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6
Q

How can anaemia cause angina?

A

Reduces the transport, so not as much O2 delivered to myocardium

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7
Q

In what pathological conditions would O2 demand be increase, and so have the capacity to cause angina?

A

Left ventricular hypertrophy (LVH)

Thyrotoxis (hyperthyroidism)

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8
Q

What can cause LVH?

A

Persistent hypertension
Significant aortic stenosis
Hypertrophic cardiomyopathy

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9
Q

What is stable angina?

A

Angina pectoris, a predictable pattern of chest pain

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10
Q

What situations does stable angina arise?

A

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

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11
Q

What are the characteristic of chest pain in stable angina?

A 
Restrosternal pain
Tight band/pressure
Radiation into neck, jaw, down arms 
Aggravating: with exertion, emotional stress 
Improved by GTN or rest
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12
Q

If chest pain is associated with body movements, i.e. leaning forward improves pain and leaning back makes it worse, is it likely to be stable angina?

A

No

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13
Q

If chest pain is stabbing/sharp, is it likely to be angina?

A

No - pleuritic or pericardial

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14
Q

If chest pain is localised, is it likely to be angina?

A

No

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15
Q

If there is no pattern to chest pain, is it likely to be angina?

A

No

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16
Q

If chest pain begins some time after exercise, is it likely to be angina?

A

No

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17
Q

If chest pain lasts for hours, is it likely to be angina?

A

No

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18
Q

List differential diagnoses for chest pain: CVD causes

A

Aortic dissection

Pericarditis

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19
Q

List differential diagnoses for chest pain: respiratory causes

A

Pneumonia
Pleurisy
Peripheral pulmonary emboli

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20
Q

List differential diagnoses for chest pain: musculoskeletal

A

Cervical disease
Costochondritis
Muscle spasm
Strain

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21
Q

List differential diagnoses for chest pain: GI causes

A 
Gastro-oesophageal reflux 
Oesophageal spasm
Peptic ulceration 
Biliary colic 
Cholecystitis 
Pancreatitis
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22
Q

What are other symptoms of myocardial ischaemia on exertion other than chest pain?

A

Breathlessness
Excessive fatigue
Near syncope

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23
Q

What classification can be used to determine severity of angina?

A

Canadian classification of angina severity (CCS)

24
Q

Define the classification of severity in the CCS

A

I - symptoms only on exertion
II - symptoms walking > 1 flight of stairs
III - symptoms walking 1 flight of stairs
IV - symptoms on any activity

25
Name modifiable risk factors
``` Smoking Lifestyle - exercise & diet Diabetes mellitus Hypertension Hyperlipidaemia ```
26
Non-modifiable risk factors
``` Age Gender Race - south asians (high diabetes rate) FH Genetic factors ```
27
Signs of stable angina
``` Tar staining on fingers Obesity Corneal scrubs Xanthalasma Hypertension Abdominal aortic aneurysm arterial bruits Absent or reduced peripheral pulses Diabetic retinopathy, hypertensive retinopathy ```
28
Signs of exacerbating conditions:
Pallor of anaemia Tachycardia Tremor Ejection systolic murmur Plateau pulse of aortic stenosis Pansystolic murmur of mitral regurgitation HF: basal crackles, elevated JVP, peripheral oedema
29
What is a plateau pulse
The time taken to reach the peak is prolonged and the entire wave is flattened and of small amplitude In aortic stenosis, the rate of ejection of blood into the aorta is decreased so that the duration of the ejection is prolonged. The amplitude of the pulse is diminished as a consequence
30
List the investigations used
``` FBC Lipid profile Fasting glucose U+E LFT TFT CXR ECG Exercise Tolerance test Myocardial Perfusion Imaging ```
31
Why use CXR to investigate?
Can show other causes of chest pain and show pulmonary oedema
32
Why use ECG to investigate?
Evidence of: Prior MI (pathological Q waves) LVH - ST segment depression
33
What test can confirm diagnosis of angina?
Exercise tolerance test Shows typical symptoms and ST-segment depression
34
Why use myocardial perfusion imaging?
Better than ETT in showing coronary artery disease, localisation of ischameia and assessing size of area affected Involves radiotherapy, use when ETT not available
35
How is the ischaemia induced in myocardial perfusion imaging?
Exercise Pharmacological stress: adenosine, dipyridamole or dobutamine Radionuclide tracer injected at peak stress
36
How to determine if ischaemia is present?
Take to imagine: one at rest and at peak stress and compare Tracer seen at rest but not at stress = ischaemia Tracer not seen at all = infarction
37
What investigation can be used to diagnose stable angina?
CT coronary angiography
38
When to carry out a CT coronary angiography
``` Strongly positive ETT Angina with no benefit from therapy Diagnosis unclear after non-invasive tests Young cardiac patients Occupation or lifestyle risks ```
39
Benefit of using CT coronary angiography/cardiac catheterisation?
Defines coronary anatomy, nature of atheromatous disease and helps decision over what treatment is possible: Just meds or PCI or CABG
40
Features of CT angiography
Under local anaesthetic Cannula inserted to femoral or radial artery Coronary catheter passes to aortic root then coronary aa. Radio-opaque contrast injected down aa. and seen on Xray
41
General measure taken for treatment of stable angina
``` Adress risk factors: BP Diabetes mellitus Cholesterol Lifestyle ```
42
What revascularisation treatment is there and when to use them?
Percutaneous coronary intervention (PCI) | Coronary artery bypass (CABG)
43
What drugs are used to stop the disease progression in stable angina?
Statins ACEi Aspirin
44
Effect of statins
If total cholesterol > 3.5mmol/L | Reduce LDL deposition in atheroma and stabilise atheroma by reducing risk of plaque rupture and ACS
45
Effect of ACEi
Stabilise endothelium and reduce risk of plaque rupture
46
Effect of aspirin
75mg or clopidogrel if intolerant | Protect endothelium and reduces risk of platelet aggregation
47
What drugs are used for relief of symptoms in stable angina?
B blockers Ca channel blockers Ik channel blockers Nitrates Trying to achieve HR < 60 ppm
48
Effect of B blockers
Reduce myocardial work and have anti-arhythmic effects
49
Effect of CCB drugs
Produces vasodilation Diltiazem Amlodipine
50
Effect of Ik channel blockers
Reduces SA node rate (control HR) | I.e. ivabridine
51
Effect of nitrates
Rapidly acting GTN spray for immediate use
52
Mechanism of percutaneous coronary intervention used to treat angina
Similar approach to cardiac catheter, but insert a wguidewire into the stenotic lesion to squash the atheromatous plaque into walls with balloon and stent
53
What drugs are taken after PCI and why?
Aspirin and clopidogrel | To allow endothelium to cover stent so that it is no longer seen are a foreign body with risk of thrombosis
54
What type of patient will receive a prognostic benefit from CABG?
> 70% stenosis of L main stem artery Proximal three-vessel coronary artery disease Two vessel coronary artery disease with stenosis of LAD and ejection fraction < 50%
55
Mechanism of CABG
Long saphenous vein harvested then reversed and used as coronary artery bypass graft

Cardiovascular System (37 decks)

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