3+ Ischaemic Heart Disease- Angina Flashcards
What is ischaemic heart disease?
A mismatch between myocardial oxygen supply and demand, presenting typically as chest pain
What are the two types of angina?
Stable angina:
- Induced by effort (increased HR and afterload)
- Relieved by rest
Unstable angina:
- Increases in frequency or severity
- Occurs with minimal exertion or at rest
What % of the population has IHD?
40%
What is the aetiology of IHD?
Atherosclerosis/CAD!!!
Anaemia
Coronary artery spasm
HCM
Tachyarrythmias
What are some precipitants of an angina episode?
Physical exertion
Emotional stressors
Cold weather
Heavy metals
What is the pathophysiology of ishcaemic heart disease?
- Mismatch between myocardial oxygen requirements and oxygen supply
Increased oxygen requirements: increased HR, increased afterload
Decreased oxygen supply:
- Atherosclerosis
- Thromboembolism
- Vasospasms
What is the clinical presentation of angina?
- Retrosternal chest pain or pressure
- May radiate to jaw, left arm, neck, epigastric
- Pain doesn’t change with position or respiration
- No tenderness over chest wall
- Dyspnoea
- Autonomic symptoms: diaphoresis, N/V, syncope
Ex:
- Maybe signs of athero? bruits, loss of peripheral pylses
What symptoms favour stable angina?
- Reproducible symptoms
- Only last minutes
- Stop with rest or nitro-glycerine
What symptoms favour unstable angina?
- Symptoms aren’t predictable
- Occur at rest with minimal exertion
- Not relieved by nitro-glycerine
- Increasing in frequency and intensity
What Ix do you do for angina?
Beside: ECG usually normal
Labs:
- FBC
- TFTs
- Lipid profile
- Trop?
Cardiac stress test: dobutamine and exercise until target HR
Coronary angiogram:
- Gold standard for persistent angina
What is the non-pharmacological management of angina?
Lifestyle optimisation:
- Smoking cessation
- Exercise
- Diet
What is the pharm management of angina?
- All need aspirin
- All need statin
1st line= B blocker with PRN Nitrates
2nd line= Ca Channel Blocker with PRN Nitrates
What is the surgical management of angina?
Percutaneous Coronary Intervention (PCI):
- Balloon inflation in stenosed artery + stenting
- DAPT (aspirin and clopidogrel (ADP antagonist) for 12 months)
Coronary Artery Bypass Graft (CABG)
- Better outcomes for younger patients
What are the complications of IHD?
Acute Coronary Syndrome/MI
- 1/4 will have an MI in the first 5 years
Heart failure
Ischaemic cardiomyopathy
