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Week 126 Chronic stable angina > Week 126 Chronic Stable Angina > Flashcards

Week 126 Chronic Stable Angina Flashcards

0
Q

Name some non-ischaemic cardiovascular Ddx for someone with chest pain

A

Aortic dissection

Pericarditis

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1
Q

What is the definition of stable angina?

What is it’s cause?

A

Chest pain/discomfort which is caused by reversible ischaemia to the myocardium, brought on by increased work load and relieved by rest. Reversible ischaemia is usually due to CAD

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2
Q

Name some pulmonary causes of chest pain (4)

A

PE
PneumoTx
Pneumonia
Pleuritis

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3
Q

Name some GIT causes of chest pain (9 listed)

A 
Oesophagitis
Oesophageal spasm
Reflux
Biliary colic
Cholecystitis
Choledocholithiasis
Cholangitis
Peptic ulcer
Pancreatitis
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4
Q

Name some chest wall causes of chest pain (5 listed)

A 
Costochondritis
Fibrositis
Rib fracture
SC arthritis
Herpes zoster
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5
Q

Name 4 life threatening causes of chest pain

A

MI
PE
Tension pneumoTx
Dissecting aortic aneurism

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6
Q

What is a fatty streak in an artery composed of?

A

Lipid (cholesterol)
Macrophages
T lymphocytes

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7
Q

What makes up the fibrous cap of an atherosclerotic plaque?

A

SM cells
Elastin
Collagen
Proteoglycans

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8
Q

What is the outcome of an imbalance of demand/supply in the myocardium?

A

Metabolic changes
Diastolic and contractile dysfunction
Electrophysiological abnormalities
Symptoms…angina

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9
Q

What are most MIs caused by?

A

Plaque rupture rather than occlusion of the coronary arteries

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10
Q

How can anaemia lead to angina?

A

Not enough oxygen to the myocardium

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11
Q

Name some non-atherosclerotic causes of CAD (note - very uncommon, 6 listed)

A

Congenital- anomalous origin of the coronary arteries
Arteritis - associated with autoimmune diseases like SLE
Coronary etasia
Radiotherapy
Syndrome X
Prinzmental’s angina

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12
Q

How many classes of angina are there?

A

4

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13
Q

What is Class 1 angina?

A

Angina caused by strenuous/protracted excercise

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14
Q

What is Class 2 angina?

A

Slight limitation with vigorous physical activity eg walking up a hill

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15
Q

What is Class 3 angina?

A

Marked limitation with symptoms during activities of daily living

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16
Q

What is Class 4 angina?

A

Inability to perform ADL with angina at rest

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17
Q

Why is there a problem with pre-testing asymptomatic individuals?

A

There’s a high rate of false positives

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18
Q

If the chest pain is well localised, what is the most likely cause?

A

Pleuritic in origin

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19
Q

Which feature on an ECG is an important predictor of acute coronary syndrome?

A

New Q waves

20
Q

What feature may be seen on an ECG of a pt with angina?

A

ST elevation/depression

21
Q

Why would a CXR be useful to do in a pt with angina?

A

To rule out any other causes eg pulmonary

22
Q

What is the target heart rate when doing an ETT?

A

220- age in years

23
Q

When is an ETT stopped?

A

If marked ST depression or sustained arrythmias present on ECG

24
Q

What are the absolute contraindications for ETT? (7 listed)

A 
MI
Unstable angina
Uncontrolled arrhythmias
Symptomatic heart failure/aortic stenosis
Acute PE
Acute myocarditis
Acute dissection
25
Q

Which drug is used in a stress ECHO?

A

Dobutamine

26
Q

Which stress agent is used when performing myocardial perfusion testing?

A

Adeosine

27
Q

Which scan has better spatial resolution than myocardial perfusion testing?

A

PET scan

28
Q

Which anatomical test/investigation is useful to visualise plaques?

A

CT coronary angiography

29
Q

Which test is useful to determine the histology of atherosclerotic plaques in the coronary arteries?

A

Intravascular ultrasound

30
Q

What is the medical treatment for angina? (Name 4 of 10 listed)

A 
Beta blockers
Anti platelets
Statins 
ACE inhibitors 
Nondihydropyridine calcium channel blocker
Ivabradine
Dihydropyridine ca agonists
Nitrates
Nicorandil
Ranolazine ....ect
31
Q

Which channels does the drug Ivabradine inhibit? What is the effect of this?

A

‘Funny’ channels which are associated with the SA and AV nodes - slows HR

32
Q

How does hypertrophic cardio myopathy lead to angina?

A

Myocardium is thicker and therefore requires a higher supply of oxygen

33
Q

What is the term to describe: lack of oxygen resulting in decrease of aerobic oxidative respiration resulting in cell injury?

A

Hypoxia

34
Q

What is the term used to describe: Lack of blood supply from a stenotic/occluded artery or reduced venous drainage resulting in lack of oxygen and essential metabolites?

A

Ischaemia

35
Q

Which causes cell injury more rapidly:

Hypoxia or ischaemia?

A

Ischaemia

36
Q

Which term describes:

irreversible cell damage due to ischaemia and hypoxia?

A

Infarction

37
Q

Name some causes of cell injury (7 listed)

A 
Hypoxia
Infections
Metabolic/nutritional
Trauma
Drugs/chemicals
Autoimmune
Genetic causes
38
Q

What are the 4 features in the pathophysiology of cell injury?

A
  1. Decreased ATP
  2. Membrane damage
  3. Increased intracellular calcium
  4. Increased oxygen derived free radicals
39
Q

What is the result of decreased Na/K pump in cell injury?

A

Influx of calcium and water. Efflux of potassium leading to ER swelling and cell swelling -> loss of microvilli etc

40
Q

What is the result of increased anaerobic glycolysis in cell injury?

A

Decreased glycogen and decreased pH leading to clumping of chromatin

41
Q

Decrease in synthesis of what leads to membrane damage?

A

Phospholipid synthesis1

42
Q

What is the result of an increase in intracellular calcium?

A

Activation of phospholipases, proteases and ATPase which breaks down the cell membrane and cytoskeleton and decreases ATP

43
Q

What is ischaemia-reperfusion injury?

A

When blood is restored to ischaemic tissues resulting in an inflammatory response and damage of cellular proteins, DNA and the plasma membrane by the re-introduction of oxygen intracellularly

44
Q

What are the complications of atherosclerosis? (4 listed)

A

Gradual narrowing of arteries
Ulceration of the plaques
Rupture/fissuring of the plaques
Superimposed thrombosis

45
Q

What are the main differences between a stable and an unstable plaque?

A

Stable: concentric narrowing; rich in stroma and SM
Unstable: Eccentric narrowing; rich in lipids, SM with inflammation + endothelial cell injury

46
Q

What are the major risk factors for atherosclerosis?

A

Smoking
HTN
Hyperlipidaemia
Diabetes

47
Q

Name some complications of MIs (7 listed)

A 
Sudden cardiac death
Arrhythmias
Left ventricular failure
Ventricular hypertrophy
Papillary muscle fibrosis
Mural thrombosis
Ventricular aneurism

Week 126 Chronic stable angina (1 decks)

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