Stable Angina Flashcards
Define angina
Clinical syndrome characterised by discomfort in chest, jaw, shoulder, back or arm
Aggravated by exertion or emotional stress
Relieved by nitroglycerin
retrosternal
associated with nausea and vomiting
2 hours
Who does angina usually occur in?
Patients with CAD involving at least 1 major epicardial artery
Unstable vs Stable
Unstable = occurs during rest, severe new onset, worsens Stable = for several weeks, predictable, with deterioration
Treatment for stable angina
PCI or CABG for symptom relief
Treatment for unstable
Antiplatelet
PCI or CABG = has prognostic benefit
What causes angina?
Myocardial ischaemia
Due to Lack of oxygen supply or increased demand
How may oxygen demand increase?
LVH secondary to HTN, AS, HCM
Thyrotoxicosis
How may oxygen supply decrease?
CAD
Anaemia
Hypoxia
Stable Angina Presentation
- central chest pain
- radiates to arm, neck, jaw teeth
- heavy, pressure, tight
- precipitated by exertion/emotion
- relived by GTN, rest
- exacerbated by cold weather, hills
- associated with SOB
- lasts for minutes
Who does stable angina commonly affect?
Old man smokers = stop HTN High cholesterol = statins Diabetic = measure blood glucose
BP Target for patient with stable angina
<130/80
What to do on exam for stable angina?
Measure BP
Listen for murmurs of AS or HCM
Look for xanthelasma
What diagnostic tests to do?
- exercise ECG
- nucelear myocardial perfusion imaging
- MRI myocardial perfusion imaging
- stress echo
- compare each image above to those taken during stress
- invasive coronary angiogram
- CT coronary angiography
What to do if likelihood of CAD is 61-90%?
Offer invasive coronary angiography as first line diagnosis
What to do if likelihood of CAD is 30-60%?
Offer functional imagine as first line
