Week 2 - Stable Angina Flashcards
What is angina?
chest pain on exertion. symptoms when there is ischaemia to myocardial cells, with no necrosis or damage
What are common causes of stable angina?
- obstructive coronary atheroma,
- abnormal coronary flow (obstructive coronary artery disease),
- coronary artery spasm
what gives angina symptoms?
exercising due to increased myocardial o2 demand.
Why may there be an increased myocardial O2 demand?
- left ventricular hypertrophy due to years of hypertension,
- significant aortic stenosis,
- thickened heart muscle
what is stable angina vs unstable angina?
unstable - fully occluded vessel, gives ischaemic chest pain on relaxation
What are the characteristics of stable angina pain?
- 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.
What can a patient take to make symptoms dissapear rapidly?
GTN (glyceryl trinitrate) spray
What symptoms AREN’T stable angina pain?
- short sharp stabbing.
- localised to a point.
- tender to touch.
- no pattern or association with physical activity.
What are some differentials for chest pain?
- pericarditis,
- aortic dissection,
- resp. causes,
- musculoskeletal,
- gas reflux,
- muscle spasms
How do you define severity of angina?
CCS 1-4 scale. canadian classification of angina severity. 1 is on significant exertion. 4 is when dressing or any activity.
What are some modifiable risk factors?
- smoking,
- lifestyle,
- diet,
- diabetes,
- hypertension,
- hyperlipidaemia
How do you diagnose?
look for signs of:
- diabetes
- hypercholesterolaemia
- heart failure
- obesity
What are signs of hypercholesterolaemia?
xanthalasma (yellow choelsterol spots near eye)
corneal arcus (pale ring around iris made of fat deposits)
What investigations do you carry out to diagnose angina?
bloods, lipids, fasting glucose, liver and thyroid tetss,
CXR to eliminate alternatives
ECG in case of valvular issuer of left ventricular hypertrophy
Why are thyroid tests carried out in investigations?
thyroid hormones control metabolism. too much = hypermetabolism leads to increased o2 demand
What non-invasive tests can you do to test for angina?
- ETT checking ECG for ischaemia.
- Myocardial perfusion imaging using PET before and after exertion
- CT scan coronary artery
- stress ultrasound to see contractility + flow
What invasive tests can you do to test for angina? why?
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.
What forms of treatment are offered for stable angina?
- lifestyle controls,
- medical treatment,
- symptom reliever,
- surgical options
What lifestyle controls are used to treat angina?
address CVD risk factors - cholesterol, diabetes, blood pressure, physical activity, smoking
What types of drugs are used to treat stable angina?
ACE inhibitors
b blockers
CCB’s
statins
aspirin + other antiplatalet drugs
vasodilators
What treatments are used to relieve symptoms?
- reduce myocardial heart rate. beta blockers and CCB’s do this.
- nitrates for vasodilation
What methods of surgical revascularisation are there?
CABG and percutaneous coronary intervention
How does CABG work?
dissection of great saphenous vein and uses as graft to reroute blood around blocked artery - can be multi-vessel.
How does percutaneous coronary intervention work?
needle puncture to coronary artery - allows you to crush atheroma to vessel wall and leave metal stent
Percutaneous coronary intervention vs CABG?
CABG is riskier, but 80% of patients are symptom free after 5 years
Which patients get CABG treatment?
those with severe 3 vessel disease or 2 vessel disease with significant stenosed arteries and low ejection fraction
