Stable Angina and Coronary Heart Disease Flashcards
What is angina?
Cardiac chest pain
What is myocardial ischemia?
When there is a mismatch between the myocardial supply and demand of Oxygen and metabolites
What is the most common cause of myocardial ischemia?
Reduced coronary blood flow to the myocardium
What are 2 less common causes of myocardial ischaemia
Reduced oxygen transport (anaemia)
Pathologically increased myocardial oxygen demand
What is the most common cause of reduced oxygen transport?
Anaemia
What is the most common cause of pathologically increased myocardial oxygen demand?
LVH (left ventricular hypertrophy)
What is the most common cause of angina?
Coronary atheroma
What does myocardial ischaemia lead to?
Angina
What happens to myocardial oxygen demand when HR and BP increase?
Demand increases
What are 4 lifestyle-related causes of increased myocardial oxygen demand?
Exertion
Stress
Cold weather
After a large meal
Where anatomically is angina often felt?
Retrosternally
What is the typical character of angina pain?
Tight band/heavy/pressure
Where can angina pain radiate to? (2)
Neck (and jaw)
Arms
What 4 systems can cause angina pain?
CVS
Respiratory
Musculoskeletal
GI
What are 2 CVS causes of angina pain?
Aortic dissection
Pericarditis
What are 2 Respiratory causes of angina pain?
Pneumonia
Pleurisy
What are 2 Musculoskeletal causes of angina pain?
Cervical disease
Muscle spasm or strain
What are 2 GI causes of angina pain?
Gastro-oesphageal reflux
Pancreatis
What are 2 situations in which myocardial ischaemia occurs with no chest pain?
Elderly
If patient has diabetes mellitus
What are 3 medical risk factors for coronary artery disease?
Diabetes mellitus
Hypertension
Hyperlipidaemia
What are 4 features you may be able to identify on examination for stable angina?
Tar Stains Obesity Xanthalasma Corneal arcus Abdominal aortic aneurysm Absent or reduced peripheral pulses
What are 7 investigations you may perform to diagnose stable angina?
Bloods (FBC, etc) CXR ECG ETT (exercise tolerance test) Myocardial perfusion imaging CT coronary angiography Cardiac catherisation
What 2 general medical risk factors would you look at reducing for stable angina?
BP
Cholesterol
If stable angina symptoms were not controlled after drug intervention then what would be done?
Revascularisation
What are the 2 main types of revascularisation?
PCI (Percutaneous coronary intervention)
CABG (Coronary artery bypass grafting)
What 3 types of drugs would be administered to reduce the disease progression of stable angina and when should they be used?
Statins (if high total cholesterol)0
ACE inhibitors (if increased CV risk and atheroma)
Asprin
What 4 types of drugs should be used for relief of stable angina symptoms?
Calcium channel blockers
Nitrates
Potassium channel openers
Beta blockers
What is done in PCI (percutaneous coronary intervention)?
Stenting regions identified by coronary angiography
What is the most common symptom of coronary heart disease?
Angina
What are 3 medical risk factors for coronary heart disease?
Hypertension
Hyperlipidaemia
Hyperglycaemia
What are 3 social risk factors for coronary heart disease?
Male
Post-menopausal
Smoking
What are 3 rate limiting drugs to treat coronary heart disease?
Beta blockers
Ivabradine
CCBs
What are 2 vasodilating drugs to treat coronary heart disease?
CCBs
Nitrates
What is the rebound phenomena (in relation to beta blocker)?
When beta blockers are suddenly taken away as treatment it can actually cause an MI
What are 4 contraindications of beta blockers?
Asthma
Peripheral vascular disease
Heart failure
Bradycardia
What are 3 adverse drug reactions of beta blockers?
Fatigue
Impotence
Bradycardia
What is the main nitrate vasodilating drug?
GTN (glyceryl trinitrate)
What are 2 adverse drug reactions to nitrates?
Headache
Hypotension
What is the main potassium channel opening drug?
Nicorandil
What is the 2 main anti-platelet drugs?
Asprin
Clopidigrol
What are 2 examples of statins?
Simvastatin
Pravastatin
What is the term used to describe when there is a lack of blood supply to an organ/tissue leading to a lack of oxygen supply?
Hypoxia
What are the 4 types of hypoxia?
Hypoxic
Anaemic
Stagnant
Cytotoxic
What is hypoxic hypoxia?
When there is either:
- Low inspired oxygen level
- Normal inspired oxygen but low partial pressure of oxygen
What is anaemic hypoxia?
Oxygen that is inspired is normal but the oxygen in the blood stream is abnormal
What is stagnant hypoxia?
inspired oxygen is normal but the delivery is abnormal (i.e. occlusion of a vessel)
What is cytotoxic hypoxia?
Oxygen is normal at inspiration but abnormal at the tissues
What is the definition of infarction?
The obstruction of blood flow
What are 4 examples of infarctions?
Thrombosis
Embolism
Strangulation
Trauma (to vessels)
What 4 factors is the extent of damage from an infarction/ischaemia dependant on?
Time
Tissue/organ affected
Pattern of blood flow
Previous diseases
What is a myocardial infarction?
Cell death due to ischaemia
What is the difference between a major or minor infarction?
The degree of coronary artery occlusion
What is used to detect cardiac cell death?
Positive cardiac biomarkers
What is a STEMI MI caused by?
Completely occluded artery
If the patient is having a STEMI MI what is the main interventional treatment?
PCI in a cath lab
What interventional treatment should be given to a patient with STEMI MI if there is no cath nearby?
Thrombolysis
What should a patient with suspected ACG be monitiered with in the hospital?
Cardiac moniter
What procedure should patients with NSTEMI be given if they are at high risk?
Angiogram
What are 4 risks of interventional treatment for ACS?
Bleeding
Blood vessel damages
MI
Stroke
Where is troponin contained in?
Cardiac myocytes
Why is troponin in the blood stream a precursor for MI?
Shows that there are problems with myocardial cells
What are 4 drug types used to treat MI
Asprin
B blockers
ACEI
Statins
