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CVS Block > Week 2 - Stable Angina > Flashcards

Week 2 - Stable Angina Flashcards

1
Q

What is angina?

A

chest pain on exertion. symptoms when there is ischaemia to myocardial cells, with no necrosis or damage

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2
Q

What are common causes of stable angina?

A
  • obstructive coronary atheroma,
  • abnormal coronary flow (obstructive coronary artery disease),
  • coronary artery spasm
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3
Q

what gives angina symptoms?

A

exercising due to increased myocardial o2 demand.

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4
Q

Why may there be an increased myocardial O2 demand?

A
  • left ventricular hypertrophy due to years of hypertension,
  • significant aortic stenosis,
  • thickened heart muscle
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5
Q

what is stable angina vs unstable angina?

A

unstable - fully occluded vessel, gives ischaemic chest pain on relaxation

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6
Q

What are the characteristics of stable angina pain?

A
  • its retrosternal,
  • more like tightness, heaviness or pressure.
  • radiates to arm, neck, jaw.
  • symptoms get worse on high myocardial o2 demand and go away after rest.
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7
Q

What can a patient take to make symptoms dissapear rapidly?

A

GTN (glyceryl trinitrate) spray

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8
Q

What symptoms AREN’T stable angina pain?

A
  • short sharp stabbing.
  • localised to a point.
  • tender to touch.
  • no pattern or association with physical activity.
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9
Q

What are some differentials for chest pain?

A
  • pericarditis,
  • aortic dissection,
  • resp. causes,
  • musculoskeletal,
  • gas reflux,
  • muscle spasms
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10
Q

How do you define severity of angina?

A

CCS 1-4 scale. canadian classification of angina severity. 1 is on significant exertion. 4 is when dressing or any activity.

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11
Q

What are some modifiable risk factors?

A
  • smoking,
  • lifestyle,
  • diet,
  • diabetes,
  • hypertension,
  • hyperlipidaemia
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12
Q

How do you diagnose?

A

look for signs of:
- diabetes
- hypercholesterolaemia
- heart failure
- obesity

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13
Q

What are signs of hypercholesterolaemia?

A

xanthalasma (yellow choelsterol spots near eye)

corneal arcus (pale ring around iris made of fat deposits)

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14
Q

What investigations do you carry out to diagnose angina?

A

bloods, lipids, fasting glucose, liver and thyroid tetss,

CXR to eliminate alternatives

ECG in case of valvular issuer of left ventricular hypertrophy

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15
Q

Why are thyroid tests carried out in investigations?

A

thyroid hormones control metabolism. too much = hypermetabolism leads to increased o2 demand

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16
Q

What non-invasive tests can you do to test for angina?

A
  • ETT checking ECG for ischaemia.
  • Myocardial perfusion imaging using PET before and after exertion
  • CT scan coronary artery
  • stress ultrasound to see contractility + flow
17
Q

What invasive tests can you do to test for angina? why?

A

non-invasive may have not given clear answer.

cardiac catheterisation/angiogram - local anaesthetic, go through radial or femoral artery, through aortic root and into coronary arteries. contrast used, seen using Xray.

18
Q

What forms of treatment are offered for stable angina?

A
  • lifestyle controls,
  • medical treatment,
  • symptom reliever,
  • surgical options
19
Q

What lifestyle controls are used to treat angina?

A

address CVD risk factors - cholesterol, diabetes, blood pressure, physical activity, smoking

20
Q

What types of drugs are used to treat stable angina?

A

ACE inhibitors
b blockers
CCB’s
statins
aspirin + other antiplatalet drugs
vasodilators

21
Q

What treatments are used to relieve symptoms?

A
  • reduce myocardial heart rate. beta blockers and CCB’s do this.
  • nitrates for vasodilation
22
Q

What methods of surgical revascularisation are there?

A

CABG and percutaneous coronary intervention

23
Q

How does CABG work?

A

dissection of great saphenous vein and uses as graft to reroute blood around blocked artery - can be multi-vessel.

24
Q

How does percutaneous coronary intervention work?

A

needle puncture to coronary artery - allows you to crush atheroma to vessel wall and leave metal stent

25
Q

Percutaneous coronary intervention vs CABG?

A

CABG is riskier, but 80% of patients are symptom free after 5 years

26
Q

Which patients get CABG treatment?

A

those with severe 3 vessel disease or 2 vessel disease with significant stenosed arteries and low ejection fraction

CVS Block (37 decks)

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