angina Flashcards
what is angina
chest pain that happens because due to a restricted blood supply to the heart.
(usually because of atherosclerotic plaques in the coronary arteries which cause reduced blood supply so reduced oxygen to the heart)
what is stable angina
predictable chest pain/pressure caused by exercise or stress because of an increase in myocardial oxygen demand
name the symptoms of angina
chest pain (can radiate to back/neck/jaw/shoulders) which is relieved by rest
what is Prinzmetal’s or vasospastic angina
a rare form of angina where the blood vessels are narrowed due to spasms. chest pain occurs during rest (NOT during exercise)
what drug is used to immediately relieve the symptoms of an acute angina attack
sublingual glyceryl trinitrate (can also use oral tablets)
causes vasodilation
what is the first line treatment for long-term prevention of chest pain in patients with stable angina
how do they work
beta-blockers e.g atenolol, bisoprolol, metoprolol or propranolol
they reduce cardiac workload so less pressure on the heart during exercise
what is the alternative treatment for long-term prevention of chest pain if beta blockers are not tolerated
can use:
- rate-limiting calcium channel blocker e.g verapamil or diltiazem
- Dihydropyridine calcium channel blockers (amlodipine) can also be used in Prinzmetal angina
what drug class is contraindicated in patients with Prinzmetal (or Vasospastic) angina
beta-blockers are contraindicated in patients with this condition
name some common side effects of glyceryl trinitrate
headache, dizziness, flushing
what should you do if a beta-blocker alone fails to control symptoms in long-term prevention of chest pain
can use a combination of beta-blocker and a calcium channel blocker
what should you do if a combination of two drugs fails to control long-term angina symptoms
refer to specialist
when would long acting nitrates e.g ivabradine, nicorandil, or ranolazine be used in angina treatment
if a patient can’t take both beta blockers and calcium channel blockers (due to intolerance or contraindicated)
why should all patients with stable angina due to atherosclerotic disease be given low dose aspirin + a statin
because all patients with angina are considered at high risk of cardiovascular events.
low dose aspirin + statin is part of secondary prevention of cardiovascular events
which drugs are given to all patients with stable angina (due to atherosclerotic disease)
low dose aspirin + statin
when would you consider a coronary artery bypass graft or percutaneous coronary intervention (e.g stent) in patients with stable angina
if they still have symptoms despite being on optimal drug therapy
