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Cardiovascular System > Stable Angina > Flashcards

Stable Angina Flashcards

1
Q

Angina

A

A discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis

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2
Q

Stable angina pathophysiology

A

Mismatch between supply of oxygen and metabolites to myocardium and the myocardial demand for them

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3
Q

Stable angina can be caused by

A

Reduction in coronary blood flow to myocardium
Reduced oxygen transport
Increased myocardial oxygen demand

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4
Q

Most common cause of angina

A

Coronary atheroma

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5
Q

Myocardial oxygen demand increases in situation where

A

Heart rate and blood pressure rise

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6
Q

Stable angina can be precipitated by

A

Exertion
Cold weather
Emotional stress
Following a heavy meal

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7
Q

History of pain in angina

A

Retrosternal
Tight band/pressure/heaviness
Radiation to neck and/or into jaw, down arms
Aggravating with exertion, emotional stress
Relieving factors of rapid movement with GTN or physical rest

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8
Q

Differential diagnosis for chest pain

A

Other cardiovascular cause
Respiratory
Musculoskeletal
GI causes

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9
Q

Symptoms of angina on exertion

A

Dyspnoea
Excessive fatigue
Near syncope
Chest pain

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10
Q

Type I angina

A

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

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11
Q

Type II angina

A

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

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12
Q

Type III angina

A

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

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13
Q

Type IV

A

Symptoms on any activity, getting washed/dressed causes symptoms

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14
Q

Non-modifable risk factors for stable angina

A 
Age
Gender
Creed
Family history 
Genetic factors
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15
Q

Modifiable risk factors of stable angina

A 
Smoking 
Lifestyle
Diabetes mellitus
Hypertension
Hyperlipidaemia
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16
Q

Diseases that can cause stable angina

A 
Obstructive coronary atheroma
Coronary artery spasm
Coronary inflammation/arteritis
Anaemia
Left ventricular hypertrophy
Aortic stenosis
Hypertrophic cardiomyopathy
Thyrotoxicosis
17
Q

Examination findings of stable angina

A 
Tar stains on fingers
Obesity
Xanthalasma and corneal arcus
Hypertension
Abdominal aortic aneurysm
Arterial bruits (murmurs)
Absent or reduced peripheral pulses
Diabetic retinopathy, hypertensive retinopathy on fundoscopy
18
Q

Examination findings of exacerbating or associated conditions of stable angina

A

Pallor of anaemia
Tachycardia, tremor, hyper-reflexia or hyperthyroidism
Ejecting systolic murmur, plateau pulse of aortic stenosis
Pansystolic murmur of mitral regurgitation
Sign of heart failure - basal crackles, elevated JVP, peripheral oedema

19
Q

Investigation of stable angina

A

Bloods - FBC, lipid profile, fasting glucose, electrolytes, liver, thyroid
Chest x-ray
ECG
Exercise tolerance test - ST segment depression with ECG
Myocardial perfusion imaging - comparison between stress and rest images
CT coronary angiography
Invasive angiography

20
Q

Tracer seen at rest but not after stress means

A

Ischaemia

21
Q

Tracer seen neither rest or after stress means

A

Infarction

22
Q

Investigations of chronic stable angina

A

Cardiac catheterisation/coronary angiography

23
Q

General measures of stable angina

A 
Address risk factors:
Blood pressure
Diabetes mellitus
Cholesterol
Lifestyle
24
Q

Revascularisation of stable angina is carried out if

A

Symptoms not controlled

25
Q

Revascularisation of stable angina

A

Percutaneous coronary intervention (PCI)

Coronary artery bypass grafting (CABG)

26
Q

Medical treatment to reduce disease progression of stable angina

A

Statins
ACE inhibitors
Aspirin or clopidogrel

27
Q

Medical treatment for relief of symptoms of stable angina

A 
Beta blockers
Calcium channel blockers
Potassium channel blocker
Nitrates
Sinus node inhibitor
28
Q

Percutaneous coronary intervention (PCI)

A

Coronary angioplasty and stenting

29
Q

Medication taken after PCI

A

Aspirin and clopidogrel

30
Q

Revascularisation is useful for

A

Symptoms

31
Q

PCI has a risk of

A

Restenosis

32
Q

Main investigation for high-risk angina patients

A

Coronary angiography

Cardiovascular System (27 decks)

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