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w126 stable angina -Cardiology > W126 stable angina > Flashcards

W126 stable angina Flashcards

1
Q

What is the Canadian Cardiovascular society grading 1?

A

Angina with strenuous rapid or prolonged exertion at work or recreation. Not felt when at rest.

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2
Q

What is the Canadian Cardiovascular society grading 2?

A

Angina felt slightly under normal activity. Can be caused by moderate exercise, cold or emotional stimuli.

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3
Q

What is the Canadian Cardiovascular society grading 3?

A

Marked limitation in normal activity by angina.

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4
Q

What is the Canadian Cardiovascular society grading 4

A

Inability to carry out any any physical activity without limitation due to angina.

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5
Q

What are the presenting symptoms of angina?

A

Angina is myocardial ischemia that presents as a central chest tightness or heaviness which is brought on by exertion and relieved by rest.It may radiate to 1 or both arms, the neck, jaw or teeth.

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6
Q

Precipitants of Angina?

A

Exercise, emotion, cold weather, and heavy meals.

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7
Q

Investigations for Angina?

A 
ECG
Blood profile
Exercise Stress Test
Functional imaging
Angiography
(For acute chest pain: troponin T on admission and 6
- 9 hours later.)
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8
Q

Lifestyle management for Angina?

A 
Lifestyle
–Smoking cessation
–Exercise
–Diet
Medical Therapy
Revascularisation
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9
Q

Medical therapy management for angina?

A 
Medical Therapy
–Drugs
•Antiplatelet therapy
•Beta-blockers
•Statins
•Nitrates
•Calcium channel blocker
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10
Q

Revascularisation Management for angina?

A 
–Percutaneous Coronary Intervention
•Plain Old Balloon Angioplasty
•Bare Metal Stents
•Drug Eluting Stents
–Coronary Artery Bypass Surgery
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11
Q

What is the First-line for rapid symptomatic relief of angina.

A

GTN. Glycerin trinitrate.

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12
Q

What is the method of action for Nitrates?

A

Release of nitric oxide (NO) to activate & increase cyclic-GMP to cause smooth muscle relaxation and subsequent cardiac vasodilation

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13
Q

Does angina pharmacology reduce the risk of subsequent MI?

A

No.

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14
Q

Contra-indication for Nitrates?

A

Hypotension
Aortic & mitral stenosis
Hypertrophic cardiomyopathy

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15
Q

Name 3 B-blockers?

A

BISOPROLOL
Atenolol
Metoprolol

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16
Q

What is the method of action for B-blockers?

A

Blocks B2 reseptors. Reduces sympathetic drive to cause a reduction in heart rate & myocardial contractility.

17
Q

Contraindications for B-blockers.

A

Asthma. Heart failure and 2nd +3rd heart block.

18
Q

What are the calcium channel blockers used in Angina?

A

Amlodipine
Nifedipine
Verapamil -rate limiting (option for patients where b-blockers are contraindicated).

19
Q

What is the method of action for calcium channel blockers?

A

Smooth muscle relaxation by inhibiting influx of calcium ions.

20
Q

contra indications to the use of C+ channel blockers?

A

Uncontrolled heart failure

Use within 1 month of MI

21
Q

What are 3 3rd line add in drugs for the treatment of Angina?

A

Nicorandil.
Ivabradine.
Ranolazine.

22
Q

what causes angina?

A

angina is caused by obstructive coronary artery disease sufficient to cause myocardial ischaemia by reducing
myocardial oxygen supply.

23
Q

What algorithm is used to diagnose stable angina?

A

Diamond-forrester.

24
Q

What % of arterial stenosing will present as angina?

A

> 70% stenosis. (but less stenosed arteries may also present as angina.)

25
Q

What causes artherosclerosis?

A

•Oxidised Low density lipoprotein from plasma taken up by macrophages, forming foam cells.
•Inflammatory process resulting in formation of a fibrous cap.
•Ulceration of the cap with clot formation occludes artery causing an ACS/AMI.
•Repeated cycles of rupture/healing lead to formation of
high grade stenosis

26
Q

What is the epidemiology of coronary artery disease?

A

Most common cause of death. 19% of males, 10% of women.

27
Q

Angina/CVD Risk factors

A 
Tobacco smoking
Diabetes mellitus 
Hypertension
Hyperlipidaemia
Family History
Recreational Drug 
use, eg cocaine
28
Q

What is the gold standard Angina investigative test?

A

Coronary angiography

29
Q

What is the difference between Anatomical and functional testing in the confirmation of diagnosis in angina?

A

• Anatomical tests: identify luminal narrowings (stenosis), their site and severity, e.g. Coronary angiography (GOLD standard) or multi-slice CT coronary angiography.
• Functional testing: assess for myocardial ischaemia, e.g. Myocardial perfusion scinigraphy with SPECT, stress
echocardiography, magnetic resonance coronary angiography, exercise stress test

30
Q

what tests are suitable for patients with a low likely hood of Coronary heart disease?

A
  • Calcium scoring using electron-beam CT scanning

* Multislice CT coronary angiography

31
Q

what tests are suitable for patients with a moderate likely hood of Coronary heart disease?

A 
-Functional testing 
recommended
•Stress Echocardiogram  
•Myocardial perfusion imaging
•Stress cardiac MRI
32
Q

What drug is used during an exercise stress test?

A

Dobutamine: β1 adrenoceptor agonist

33
Q

What is Myocardial Perfusion Scintigraphy?

A

Nuclear medicine test. Tc99m injected and monitered in the heart looking for areas that do not take up the isotope.

34
Q

what tests are suitable for patients with a high likely hood of Coronary heart disease?

A

Coronary angiography is the most cost-effective strategy in this patient group.

35
Q

What is the treatment for unstable angina?

A

Percutaneous coronary intervention (stenting)

CABG (bypass has a better longterm outcome)

36
Q

What is a major risk factor post treatment of Angina.

A

Diabetes miletus. Significantly raised mortality and risk of restenosing.

37
Q

What is the difference between stable and unstable angina?

A

Stable is the arthrosclerosis of the coronary arteries. this results in reduced perfusion as the heart during exercise.which results in Angina.
Unstable is thin plaque protecting a deposit of sclerosis. when this plaque ruptures it causes a clot to form as the blood reacts to the cholesterol. if the clot partially ocludes the artery, it is an NSTEMI, total block is a STEMI.

w126 stable angina -Cardiology (2 decks)

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