Stable ischemic heart disease and angina – presentation and investigation Flashcards
What is the underlying cause of stable angina?
Stable angina occurs due to myocardial ischaemia caused by fixed atherosclerotic narrowing of the coronary arteries.
What happens at the cellular level during an angina episode?
Reduced oxygen supply leads to anaerobic metabolism.
Lactic acid accumulation irritates nerve endings, causing chest pain.
What are major risk factors for stable angina?
Modifiable → Smoking, hypertension, diabetes, hyperlipidaemia, obesity, sedentary lifestyle.
Non-modifiable → Age, male gender, family history of coronary artery disease (CAD).
Which populations have the highest incidence of stable angina?
Older adults, men > women (before menopause), individuals with metabolic syndrome.
What are the classic symptoms of stable angina?
Chest pain → Tight, pressing, or squeezing discomfort.
Location → Retrosternal, may radiate to jaw, left arm, or back.
Triggers → Exercise, emotional stress, cold weather, heavy meals.
Relief → Rest or nitrates (e.g., GTN spray).
How does stable angina differ from unstable angina?
Stable angina → Predictable, occurs on exertion, relieved by rest.
Unstable angina → Occurs at rest, lasts longer, may indicate impending myocardial infarction.
What are the key diagnostic tests for stable angina?
ECG → Often normal, but may show ST depression or T wave inversion during attacks.
Exercise stress test → Identifies ischaemia by provoking symptoms.
Coronary angiography → Gold standard to visualize coronary artery blockages.
CT Coronary Angiogram (CTCA) → Non-invasive imaging for risk assessment.
Blood tests → Lipid profile, fasting glucose, cardiac enzymes (to rule out MI).
Why is diagnosing and treating stable angina important?
Prevents progression to acute coronary syndrome (ACS), reduces symptoms, and improves quality of life.
What are the main treatment options?
Lifestyle changes → Smoking cessation, exercise, diet control.
Medications:
Aspirin → Reduces clot formation.
Beta-blockers (e.g., bisoprolol) → Reduce heart rate and oxygen demand.
Calcium channel blockers (e.g., amlodipine) → Vasodilation to improve blood flow.
Nitrates (e.g., GTN spray) → Immediate symptom relief.
Lipid-lowering drugs (e.g., statins) → Reduce plaque progression.
Revascularization procedures:
Percutaneous Transluminal Coronary Angioplasty (PTCA) → Stenting to open blocked arteries.
Coronary Artery Bypass Grafting (CABG) → Used for severe multi-vessel disease.
