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Flashcards in Stable Angina Deck (38)
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1

What is angina characterised by

by discomfort in the chest, jaw, shoulder, back, or arm

2

What is angina aggrevated by

by exertion or emotional stress and relieved by nitro-glycerin

3

Who does angina often occur in

- Patients with Coronary artery disease involving at least one major epicardial artery

4

what are excaberation in angina

- cold weather - due to vasconstrictoin
- hills

5

How is unstable angina defined

Angina that presents in one of three principal ways
- rest angina
- severe new onset angina
- worsening angina

6

What is the diagnostic criteria for stable angina

Diagnostic criteria for stable angina
- Lasts 5-15 minutes
- Usually occurs with exertion or emotional stress
- Usually stops with rest or GTN spray
If you have all three features this is typical angina
If you have 2 out of 3 features this is atypical angina
If you have 0-1 of the features then this is non anginal chest pain

7

What is the treatment for stable angina

- Medical
- PCI or CABG for symptom relief

8

What is the treatment for unstable angina

- combination antiplatelet
- PCI or CABG carries prognostic benefit

9

What causes angina

- Imbalance between oxygen supply and demand
- myocardial ischaemia is present when myocardial oxygen demand exceeds myocardial oxygen supply

10

What can cause a reduction in oxygen supply derived from blood flow

- Coronary artery disease
- anaemia
- hypoxia

11

What can cause an increase in oxygen demand

- left ventricular hypertrophy secondary to - hypertension, hypertrophic cardiomyopathy, AS

12

Name the symtpoms of angina

- Site – central
- Radiation – arm(s)/neck/jaw/teeth
- Character – heavy/pressure/tight
- Precipitating factors – exertion/emotion
- Relieving factors – rest/SL GTN
- Exacerbating factors – cold weather, hills
- Associated factors – SOB
- Duration - minutes

13

Name some modifiable risk factors

- Smoking - must stop
- hypertension - target is 130/80 mmHg for patients with CVD
- hypercholestrolaemia - measure the blood cholesterol and treat with an statin
- Diabetes

14

What should you examine

- Measure blood pressure
- listen for murmurs of AS or HCM
- look for xanthelasma - high cholesterol levels

15

Name the tests that look for evidence of ischaemic heart disease (do these when patient has typical angina with evidence of ishcemic heart disease)

- Exercise ECG
- Nuclear myocardial perfusion imaging
- MRI myocardial perfusion imaging
- Stress echo

these are non invasive tests

16

Name the tests that look for coronary artery disease itself

- CT calcium score and CT coronary angiography
- Invasive coronary angiogram

17

What is the gold standard for diagnosing coronary artery disease

invasive coronary angiogram

18

What is the treatment of angina to improve prognosis

1. Aspirin
2. statin
3. ACE inhibitor
4. beta blocker if post MI

19

How does the treatment of angina improve survival

1. Aspirin - in patients with CVD reduces MI and stroke by 1/3rd and CV death by 1/6th
2. statin - reduces death or MI by 25-30% in patients with CVD
3. ACE inhibitor - reduces death, MI, or stroke by 20% in patients with CVD
4. beta blocker if post MI

20

What treatment is used in angina to improve symptoms

1. Sublingual GNT
2. Beta blocker - 1st line anti-anginal therapy

21

PCI has never been...

Show to improve outcome in stable angina

22

What are the methods of PCI

- metal lattice structures
- balloon mounted
- scaffold

23

What is decubitus angina

angina that is precipitated by lying flat

24

What is prinzmetal angina

- caused by coronary artery spasm

25

What are the indications for referral for angina

- diagnostic uncertainty
- new angina of sudden onset
- recurrent angina post MI or CABG
- uncontrolled by drugs
- unstable angina

26

What symptom relief is used for angina

GTN spray or sublingual Tablets
- repeat dose if pain has not gone after 5 minute and call ambulance if pain is still present 5 min after 2nd dose

27

What is the side effect of GTN

- headaches
- lowered blood pressure

28

What medication do you have to have after a PCI

Dual antiplatelet therapy (DAPT; aspirin + clopidogrel) for 12months

29

What are the complication of a PCI

haemorrhage, thrombosis, dissection, arterial spasm, angina, arrhythmias (usually transient), pericardial effusion, pericardial tamponade, infection

30

What are the indications for CABG

improve survival: left main stem disease, triple-vessel disease involving proximal part of LAD; relieve symptoms: angina unresponsive to drugs, unstable angina, angioplasty unsuccessful