Stable Angina Flashcards
Definition?
Pain or discomfort in chest, shoulders, neck or jaw caused by insufficient blood supply to myocardium-usually occurs predictably with physical exertion for no more than 10 mins and is relieved within minutes of rest.
Risk factors?
- Older
- Male
- CVD risk factors
- CAD
Ddx?
• ACS
• Aortic Dissection-tearing chest pain radiating to shoulder blades
• Pericarditis-sharp pain and SOB relieved on sitting forward
• Acute CHF
Arrhythmias
Epidemiology?
Age: Elderly
Sex: Male
Ethnicity:
P: CHD causing angina accounted for 45% deaths in 2014
Aetiology?
- Atheroma
- AS
- Anaemia
- Tachyarrhythmias
- Small vessel disease
CP?
- Precipitated by physical exertion
- Discomfort in neck, chest, jaw, or arms
- Relieved by GTN
- GI discomfort
- SOB
- N and V
- Sweatiness
- Faintness
Pathophysiology?
- Reduced blood flow->70% stenosis-blocked by plaque in coronary arteries
- In exercise or stress the heart works harder and can’t meet the demands metabolic of the myocardium
- Hypertrophic cardiomyopathy-thickened muscle wall needs more oxygen
- Pump against high pressure-HT and aortic stenosis
- Sub-endocardium ischaemia-stimulates adenosine and bradykinin irritates sensory/pain neurones
Investigations-first line?
CVS and resp exam and history
Investigations-second line?
ECG (ST depression)and CT angiography and full bloods to investigate causes/complications
Investigations-third line?
Invasive coronary angiography and functional imaging tests eg exercise ECG
Management-first line?
GTN before planned exertion
Drug treatment/secondary prevention of CVD
Drug treatment line?
First line: CCB or BB Second line: Swap Third line: Use combined Fourth line: • a long-acting nitrateor • ivabradineor • nicorandilor • ranolazine.
Drugs for prevention lines?
Aspirin 75mg daily
ACEi if diabetes too
Rivaroxaban if
• aged 65 or over, or
• atherosclerosis in at least 2 vascular territories (such as coronary, cerebrovascular, or peripheral arteries), or
• 2 or more of the following risk factors:
• current smoking
• diabetes
• kidney dysfunction with aneGFRof less than60 ml/min(note that rivaroxaban is contraindicated if the eGFR is less than15 ml/min)
• heart failure
previous non-lacunar ischaemic stroke
Management second line?
CABG-if coronary angiography indicates left main stem disease or proximal three-vessel disease.
PCI
Management third line?
Offer re-evaluation
Consider cardiac syndrome X
Myocardial perfusion scintigraphy
Pain Managment-spinal cord stimulation
Complications?
- Stroke
- MI
- Unstable angina
- Sudden cardiac death
- Anxiety and depression
- Reduced quality of life
Prognosis?
This varies on CAD prognosis, LV function, exercise duration and comorbidities and progression since time seen.
