Stable Angina Flashcards
What is angina?
A discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis
What is a discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis called?
Angina
What is myocardial ischaemia?
Lack of oxygen to the heart
What is a lack of oxygen to the heart called?
Myocardial ischaemia
What is ischaemia?
Restriction in blood supply to tissues causing a shortage of oxygen
What is restriction in blood supply to tissues causing a shortage of oxygen called?
Ischaemia
What is the pathophysiology of myocardial ischaemia and resultant angina symptoms?
Mismatch between supply of oxygen and metabolites to myocardium and the myocardial demand for them
What is the mismatch between nutrients delivered to the myocardium and the demand for them due to?
Most commonly due to a reduction in coronary blood flow to the myocardium
Uncommonly due to reduced oxygen transport
Uncommonly due to pathologically increased myocardial demand
What can casue a reduction in coronary blood flow to the myocardium?
Obstructive coronary atheroma (very common)
Coronary artery spasm (uncommon)
Coronary inflammation/arteritis (very rare)
What causes reduced oxygen transport?
Anaemia
What leads to pathologically increased myocardial oxygen demand?
Left ventricular hypertrophy (LVH) as seen in significant hypertension, aortic stenosis and hypertrophic cardiomyopathy
Thyrotoxicosis
What does LVH stand for?
Left ventricular hypertrophy
What is hypertrophic cardiomyopathy?
Portion of the heart becomes thickened without a known cause
What is it called when a portion of the heart becomes thickened without a known cause?
Hypertrophic cardiomyopathy
What is thyrotoxicosis?
Excess of thyroid hormone in the body
What is excess of thyroid hormone in the body called?
Thyrotoxicosis
What is the most common cause of angina?
Coronary atheroma
Why does coronary atheroma cause angina?
On activity with the increased myocardial oxygen demand obstructed coronary blood flow leads to muocardial ischaemia and tehn the symptoms of angina
Myocardial oxygen demand increases in situations where heart rate and blood pressure rise, such as exercise, anxiety/emotional stress and after a large meal
When does myocardial oxygen demand increase?
In situations where heart rate and blood pressure rise, such as exercise, anxiety/emotional stress and after a large meal
What is arteritis?
Inflammation of the walls of the arteries
What is inflammation of the walls of the arteries called?
Arteritis
What is the typical distribution of pain due to angina?
Along the chest to the left arm
How would you describe the process of atherosclerosis?
Progressive process
When does atherosclerosis go from no symptoms to stable angina to acute coronary syndromes?
Where does a lot of the diagnosis for angina come from?
The history
What is it essential to establish about the pain from angina?
The character of the pain to differentiate it from other causes of chest pain
What kind of things are needed to be known about angina pain?
Site of pain
Character of pain
Radiation sites
Aggravating
Relieving factors
What is the site of pain?
Retrosternal
What is the character of the pain?
Often tight band/pressure/heaviness
What are the radiation sites of the pain?
Neck and/or into jaw, down arms
What aggravates the pain?
Exertion and emotional stress
What are relieving factors for the pain?
Rapid improvement with GTN or physical rest
When can myocardial ischaemia occur without chest pain?
In the elderly or with diabetes mellitus due to reduced pain sensation
What other symptoms are present when pain is not for myocardial ischaemia?
Breathlessness on exertion
Excessive fatigue on exertion for activity undertaken
Near syncope on exertion
What are examples of features that make angina less likely?
Sharp/stabbing pain (pleuritic or pericardial)
Associated with body movements or respiration
Very localised (pinpoint site)
Superficial with/or without tenderness
No pattern to pain
Begins sometimes after exercise
Lasting for hours
What is required to differentiate angina from other possible causes for the pain?
Differential diagnosis
What are other systems that cause similar pain to angina?
Cardiovascular
Respiratory
Musculoskeletal
GI
What are some cardiovascular causes that are similar to angina but the pain has different characteristics?
Aortic dissection
Pericarditis
What are some respiratory causes that are similar to angina but the pain has different characteristics?
Pneumonia
Pleurisy
Peripheral pulmonary emboli