Stable Angina summary

Question 1

Causes and Pathophysiology of stable angina

Answer 1

Development: 
Simply, fatty streak, stenosis. Can cause ischemia if demand > supply. Disturbs function but no necrosis.
Risks:
Age
Gender (men 10 yrs sooner than women)
Obesity / sedentary lifestyle
Big 5: 
Family Hx (M<65 y.o.)
Smoking
Hypertension
Diabetes
Dyslipidemia

Question 2

Describe clinical syndromes of stable angina

Answer 2

I: Fine at rest, occurs with strenuous, rapid, or prolonged exertion.
II: Slight limitation, occurs in more normal activity (stairs etc.)
III: Marked limitations, occurs after walking 1 to 2 blocks, 1 flight of stairs)
IV: anginal symptoms may be present at rest (unstable)

Question 3

Symptoms of stable angina

Answer 3

Crushing chest pain/heaviness, radiating down one or both arms and/or jaw.

Question 4

Signs and Physical findings of stable angina

Answer 4

Chest pain.

Probably HTN.

Question 5

Key lab tests and findings for stable angina

Answer 5

ECG: can be normal; can see signs of damage or LVH.
Stress test ECG: see ST depression, drop in BP,
Stress echocardiogram: info on fn pre- and post-exercise
Nuclear perfusion imaging in rest and stress: MIBI and PET: see lack of blood, or lack of light up
CT: detect Ca (severe atherosclerosis) - but radiation?
Angiography: best to test severity - find wear to fix

Question 6

Tx of stable angina

Answer 6

Meds - see prevention. Esp. with stent.

Sx: Percutaneous coronary intervention = balloon/stent; Bypass.

Question 7

Prevention Tx for stable angina

Answer 7

Antiplatelet agents: ASA forever +/- clopidogrel
ACE inhibitors or Angiotensin/Aldosterone blockers
Blood pressure control: lower Na, lower EtOH, wt loss
β blockers (or other anti-anginals)
Cholesterol management: ≤ 2mM, Statin, lifestyle
Diet / Nutrition / Weight
Diabetes management
Exercise
End Smoking
End Painkillers: ASA and acetaminophen ok.
Immunization: influenza and pneumococcal, helps long term