W126 stable angina Flashcards
What is the Canadian Cardiovascular society grading 1?
Angina with strenuous rapid or prolonged exertion at work or recreation. Not felt when at rest.
What is the Canadian Cardiovascular society grading 2?
Angina felt slightly under normal activity. Can be caused by moderate exercise, cold or emotional stimuli.
What is the Canadian Cardiovascular society grading 3?
Marked limitation in normal activity by angina.
What is the Canadian Cardiovascular society grading 4
Inability to carry out any any physical activity without limitation due to angina.
What are the presenting symptoms of angina?
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.
Precipitants of Angina?
Exercise, emotion, cold weather, and heavy meals.
Investigations for Angina?
ECG Blood profile Exercise Stress Test Functional imaging Angiography (For acute chest pain: troponin T on admission and 6 - 9 hours later.)
Lifestyle management for Angina?
Lifestyle –Smoking cessation –Exercise –Diet Medical Therapy Revascularisation
Medical therapy management for angina?
Medical Therapy –Drugs •Antiplatelet therapy •Beta-blockers •Statins •Nitrates •Calcium channel blocker
Revascularisation Management for angina?
–Percutaneous Coronary Intervention •Plain Old Balloon Angioplasty •Bare Metal Stents •Drug Eluting Stents –Coronary Artery Bypass Surgery
What is the First-line for rapid symptomatic relief of angina.
GTN. Glycerin trinitrate.
What is the method of action for Nitrates?
Release of nitric oxide (NO) to activate & increase cyclic-GMP to cause smooth muscle relaxation and subsequent cardiac vasodilation
Does angina pharmacology reduce the risk of subsequent MI?
No.
Contra-indication for Nitrates?
Hypotension
Aortic & mitral stenosis
Hypertrophic cardiomyopathy
Name 3 B-blockers?
BISOPROLOL
Atenolol
Metoprolol
What is the method of action for B-blockers?
Blocks B2 reseptors. Reduces sympathetic drive to cause a reduction in heart rate & myocardial contractility.
Contraindications for B-blockers.
Asthma. Heart failure and 2nd +3rd heart block.
What are the calcium channel blockers used in Angina?
Amlodipine
Nifedipine
Verapamil -rate limiting (option for patients where b-blockers are contraindicated).
What is the method of action for calcium channel blockers?
Smooth muscle relaxation by inhibiting influx of calcium ions.
contra indications to the use of C+ channel blockers?
Uncontrolled heart failure
Use within 1 month of MI
What are 3 3rd line add in drugs for the treatment of Angina?
Nicorandil.
Ivabradine.
Ranolazine.
what causes angina?
angina is caused by obstructive coronary artery disease sufficient to cause myocardial ischaemia by reducing
myocardial oxygen supply.
What algorithm is used to diagnose stable angina?
Diamond-forrester.
What % of arterial stenosing will present as angina?
> 70% stenosis. (but less stenosed arteries may also present as angina.)
What causes artherosclerosis?
•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
What is the epidemiology of coronary artery disease?
Most common cause of death. 19% of males, 10% of women.
Angina/CVD Risk factors
Tobacco smoking Diabetes mellitus Hypertension Hyperlipidaemia Family History Recreational Drug use, eg cocaine
What is the gold standard Angina investigative test?
Coronary angiography
What is the difference between Anatomical and functional testing in the confirmation of diagnosis in angina?
• 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
what tests are suitable for patients with a low likely hood of Coronary heart disease?
- Calcium scoring using electron-beam CT scanning
* Multislice CT coronary angiography
what tests are suitable for patients with a moderate likely hood of Coronary heart disease?
-Functional testing recommended •Stress Echocardiogram •Myocardial perfusion imaging •Stress cardiac MRI
What drug is used during an exercise stress test?
Dobutamine: β1 adrenoceptor agonist
What is Myocardial Perfusion Scintigraphy?
Nuclear medicine test. Tc99m injected and monitered in the heart looking for areas that do not take up the isotope.
what tests are suitable for patients with a high likely hood of Coronary heart disease?
Coronary angiography is the most cost-effective strategy in this patient group.
What is the treatment for unstable angina?
Percutaneous coronary intervention (stenting)
CABG (bypass has a better longterm outcome)
What is a major risk factor post treatment of Angina.
Diabetes miletus. Significantly raised mortality and risk of restenosing.
What is the difference between stable and unstable angina?
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.
