Stable Coronary Artery Disease Flashcards
What are the different types of angina?
classical or exertional, decubitus, nocturnal, variant (Prinzmetal), Cardiac syndrome X and unstable.
What is Decubitus angina?
Chest pain on lying down, occurs with LV dysfunction.
What is Variant (prinzmetal) angina?
Angina pain that occurs randomly at rest due to coronary artery spasm. May cause ST segment elevation.
What is Cardiac Syndrome X?
A good history of angina with positive exercise tolerance test but normal angiography.
In examination of angina patient what CV disease must be ruled out?
Aortic stenosis. i.e a slow rising carotid impulse with ejection systolic murmur radiating to the carotids
What investigations may be carried out for angina?
Resting ECG, Exercise ECG, Cardiac scintigraphy, Echo, CT angio, CV MRI, Coronary angiography
What may be shown on an ECG during an angina attack?
ST depression, t wave inversion
How should patientients initially be managed for Angina?
They should be ressured that their prognosis is good, underlying conditions should be treated, lifestyle risk factors should be modified and treatment of existing disease should be optimised (diabetes and hypertension)
How do statins work?
Statins inhibit HMG-CoA Reductase, HMG-Coa reductase is the enzyme which converts Acytle-CoA into cholesterol and hence lowers cholesterol.
What drugs can be considered to help with symptomatic relief in Angina patients? (4)
G
What management options are available for patients with intractable angina?
Transmyocardial laser revascularisation - channels are created in the myocardium so that blood from the ventricles flows in directly and revascularises it.
Spinal Cord Stimulation- An electrode is inserted into the epidural space and a pacemaker regulated electrical impules.
