Stable Ischaemic Heart Disease Flashcards

1
Q

Define Stable Angina

A

Pain/pressure in the chest due to myocardial ischaemia without necrosis (possibly with radiation) but not at rest.

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2
Q

Name 6 causes of Stable Angina

A

Obstructive Coronary Atheroma
Coronary Artery Spasm
Coronary Artery Inflammation
Anaemia
LVH
Thyrotoxicosis

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3
Q

What are the risk factors for SIHD?

A

Old - Certain Races - Male - FH - Smoker - Low exercise - Poor Diet - Diabetes - Hypertension - Hypercholesterolaemia

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4
Q

Describe the site, character and radiation of Ischaemic heart pain?

A

Retrosternal (Centre)
Tight band/pressure or heaviness
Radiates to neck, jaw and medial arms

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5
Q

What triggers and relieves symptoms of SIHD?

A

Triggered by Stress, exertion, cold weather and large meals
Relieved by rest & GTN spray

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6
Q

What could you see on an examination of a SIHD patient?

A

Tar Staining - smoker
Obesity
Xanhalasma/Corneal Arcus - Hypercholesterolaemia
Hypertension
Retinopathy - Diabetes or Hypertension
Reduced peripheral pulses + abdominal bruit - AAA
Pallor- Anaemia
Elevated JVP, basal crackles & peripheral oedema - Heart Failure
Pansystolic murmur at mitral - Mitral Regurgitation
Ejection systolic murmur at Aortic - Aortic Stenosis
Hyperreflexia if thyrotoxicosis
Tachycardia

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7
Q

How would you investigate suspected SIHD?

A

Bloods - FBC, lipid profile, Glc, U&Es , LFTs & thyroid function
CXR
ECG
Exercise Tolerance Test (ETT)
Myocardial Perfusion Imaging
Coronary Angiography

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8
Q

What would an ECG show in a SIHD patient?

A

Pathological Q waves indicative of a past MI
High voltages, ST depression and/or Strain pattern indicates LVH

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9
Q

Whats the use of an ETT in a SIHD patient?

A

Its needed to confirm the diagnosis
A +ve test shows ST depression and typical symptoms.

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10
Q

What does coronary angiography do for SIHD patients?

A

Determines the size/location of an obstruction and what type of treatment is needed (meds vs revascularisation)
So its essential in any high risk patient

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11
Q

How do we treat Stable Angina?

A

Firstly address risk factors to prevent worse future disease.
Meds to treat symptoms and limit disease progression
Revascularisation by PCI or CABG

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12
Q

What meds treat the symptoms of angina?

A

B-blockers, CCBs, K openers (Reduces contractility and vasodilates - Nicorandil) & nitrates (Isosorbide Mononitrate)
And funny channel blocker Ivabradine which slows heart rate through increasing time to depolarisation to threshold in the pacemaker cell.

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13
Q

What meds treat the disease behind stable angina?

A

Statins
ACEIs
Aspirin or Clopidogrel

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14
Q

What type of PCI is used in coronary revascularization?

A

Percutaneous Transluminal Coronary Angioplasty

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15
Q

What are the advantages of CABG over PCI?

A

CABG is better in multi vessel disease.
Unlike PCI it can help pronostically as well as the symptoms.

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16
Q

In what unusual way can SIHD present?

A

Without pain but with SOBOE, Excessive Fatigue OE and Near Syncope OE.
USually in people with reduced pain sensation e.g. elderly & diabetics

17
Q

What is the classification of angina stages?

A

Canadian Cardiovascular Society scale of Angina Severity (CCS scale):
1 - Asymptomatic unless strenous acitvity
2 - Slight limitation e.g. walking >2 blocks or mu;tiple flights of stairs
3 - Marked Limitation e.g. i flight of stairs
4 - Cant really dress or wash etc