Stable ischaemic heart disease and angina Flashcards
Define angina pectoris
Discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis
Whats the most common cause of angina
Coronary atheroma
State some causes of angina
Obstructive coronary atheroma Coronary artery spasm Coronary inflammation/arteritis Anaemia Left ventricular hypertrophy Thyrotoxicosis Increased when undertaking physical activity
What situations increase myocardial oxygen demand?
Exertion
Cold weather
Emotional stress
Following a heavy meal
Describe some symptoms of angina
Chest pain
Breathlessness on exertion
Excessive fatigue on exertion
Near syncope on exertion
How do you define the severity of angina
Canadian classification of angina severity (CCS)
I - only on significant exertion
II - slight limitation of ordinary activity e.g. walking 2 blocks, >1 flight of stairs
III - marked limitation, walking 1 block, 1 flight of stairs
IV - symptoms on any activity e.g. getting washed/dressed
Describe some non-modifiable risk factors for angina
Age
Gender
Creed (beliefs?)
Family history and genetic factors
Describe some modifiable risk factors for angina
Smoking Lifestyle - diet and exercise Diabetes mellitus (glycaemic control) Hypertension Hyperlipidaemia
Describe some important clinical signs when investigating someone who potentially has angina
Tar stains Obesity (centripedal) Xanthelesmata and corneal arcus Hypertension Abdominal aortic aneurysm arterial bruits Absent or reduced peripheral pulses Diabetic retinopathy Hypertensive retinopathy
What can ECGs show us for angina?
Evidence of prior MI e.g. pathological Q waves
Evidence of left ventricular hypertrophy
What investigations would be carried out for angina?
Exercise tolerance test (ETT) Bloods CXR ECG Myocardial perfusion imaging CT coronary angiography Cardiac catheterisation and angiography
What would be needed to be found in an ETT test to be positive for angina?
Symptoms
Sufficient CV stress
ST-segment depression
When would invasive angiography be used?
Early or strongly positive ETT Angina refractory to treatment Unclear diagnosis Young patient High risk occupation
What 3 levels of treatment are suggested for angina patients?
General measures - reduce risk factors
Medical treatment for symptoms
Revascularisation if not controlled
Describe two means of revascularisation
Percutaneous coronary intervention
Coronary artery bypass grafting
