Stable Angina Flashcards Preview

Year 3 - CR > Stable Angina > Flashcards

Flashcards in Stable Angina Deck (38)
Loading flashcards...

What is angina characterised by

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


What is angina aggrevated by

by exertion or emotional stress and relieved by nitro-glycerin


Who does angina often occur in

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


what are excaberation in angina

- cold weather - due to vasconstrictoin
- hills


How is unstable angina defined

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


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


What is the treatment for stable angina

- Medical
- PCI or CABG for symptom relief


What is the treatment for unstable angina

- combination antiplatelet
- PCI or CABG carries prognostic benefit


What causes angina

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


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

- Coronary artery disease
- anaemia
- hypoxia


What can cause an increase in oxygen demand

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


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


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


What should you examine

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


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


Name the tests that look for coronary artery disease itself

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


What is the gold standard for diagnosing coronary artery disease

invasive coronary angiogram


What is the treatment of angina to improve prognosis

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


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


What treatment is used in angina to improve symptoms

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


PCI has never been...

Show to improve outcome in stable angina


What are the methods of PCI

- metal lattice structures
- balloon mounted
- scaffold


What is decubitus angina

angina that is precipitated by lying flat


What is prinzmetal angina

- caused by coronary artery spasm


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


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


What is the side effect of GTN

- headaches
- lowered blood pressure


What medication do you have to have after a PCI

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


What are the complication of a PCI

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


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