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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
What are the absolute contraindications for ETT? (7 listed)
``` MI Unstable angina Uncontrolled arrhythmias Symptomatic heart failure/aortic stenosis Acute PE Acute myocarditis Acute dissection ```
25
Which drug is used in a stress ECHO?
Dobutamine
26
Which stress agent is used when performing myocardial perfusion testing?
Adeosine
27
Which scan has better spatial resolution than myocardial perfusion testing?
PET scan
28
Which anatomical test/investigation is useful to visualise plaques?
CT coronary angiography
29
Which test is useful to determine the histology of atherosclerotic plaques in the coronary arteries?
Intravascular ultrasound
30
What is the medical treatment for angina? (Name 4 of 10 listed)
``` Beta blockers Anti platelets Statins ACE inhibitors Nondihydropyridine calcium channel blocker Ivabradine Dihydropyridine ca agonists Nitrates Nicorandil Ranolazine ....ect ```
31
Which channels does the drug Ivabradine inhibit? What is the effect of this?
'Funny' channels which are associated with the SA and AV nodes - slows HR
32
How does hypertrophic cardio myopathy lead to angina?
Myocardium is thicker and therefore requires a higher supply of oxygen
33
What is the term to describe: lack of oxygen resulting in decrease of aerobic oxidative respiration resulting in cell injury?
Hypoxia
34
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?
Ischaemia
35
Which causes cell injury more rapidly: Hypoxia or ischaemia?
Ischaemia
36
Which term describes: | irreversible cell damage due to ischaemia and hypoxia?
Infarction
37
Name some causes of cell injury (7 listed)
``` Hypoxia Infections Metabolic/nutritional Trauma Drugs/chemicals Autoimmune Genetic causes ```
38
What are the 4 features in the pathophysiology of cell injury?
1. Decreased ATP 2. Membrane damage 3. Increased intracellular calcium 4. Increased oxygen derived free radicals
39
What is the result of decreased Na/K pump in cell injury?
Influx of calcium and water. Efflux of potassium leading to ER swelling and cell swelling -> loss of microvilli etc
40
What is the result of increased anaerobic glycolysis in cell injury?
Decreased glycogen and decreased pH leading to clumping of chromatin
41
Decrease in synthesis of what leads to membrane damage?
Phospholipid synthesis1
42
What is the result of an increase in intracellular calcium?
Activation of phospholipases, proteases and ATPase which breaks down the cell membrane and cytoskeleton and decreases ATP
43
What is ischaemia-reperfusion injury?
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
What are the complications of atherosclerosis? (4 listed)
Gradual narrowing of arteries Ulceration of the plaques Rupture/fissuring of the plaques Superimposed thrombosis
45
What are the main differences between a stable and an unstable plaque?
Stable: concentric narrowing; rich in stroma and SM Unstable: Eccentric narrowing; rich in lipids, SM with inflammation + endothelial cell injury
46
What are the major risk factors for atherosclerosis?
Smoking HTN Hyperlipidaemia Diabetes
47
Name some complications of MIs (7 listed)
``` 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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