stable angina Flashcards
what features in patient history make angina less likely?
sharp pain in the chest,
define angina?
“ a discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis” so no damage to the cells
what is the most common cause of myocardial ischaemia?
a reduction in coronary artery blood flow to the myocardium caused most commonly by obstructive coronary atheroma
what are some things which can set on angina symptoms?
exertion, cold weather, emotional stress, following heavy meal.
how much obstruction in the coronary artery is required to induce angina symptoms?
70%
define acute coronary syndrome
Spontaneous plaque rupture & local thrombosis, with degrees of occlusion
it will give myocardial ischaemic symptoms at rest as opposed to stable angina which gives them on exertion alone
when taking a patient history, it is Essential to establish the characteristics of patients pain to differentiate from other causes of chest pain. list a few of these
Site of pain (watch for patient gestures): retrosternal
Character of pain: often tight band/pressure/heaviness.
Radiation sites: neck and/or into jaw, down arms.
Aggravating e.g. with exertion, emotional stress & relieving factors e.g. rapid improvement with GTN or physical rest.
(cardinal sign is gets worse with increased O2 demand and gets better within relief of demand)
list the 4 CCS (Canadian classification of anginal severity) tiers
I Ordinary physical activity does not cause angina, symptoms only on significant exertion.
II Slight limitation of ordinary activity, symptoms on walking 2 blocks or > 1 flight of stairs.
III Marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs.
IV Symptoms on any activity, getting washed/dressed causes symptoms
what are some of the features of angina on examination?
Tar stains on fingers.
Obesity (centripedal).
Xanthalasma and corneal arcus (hypercholesterolaemia).
Hypertension.
Abdominal aortic aneurysm arterial bruits, absent or reduced peripheral pulses.
what are the two most important tests to do on a patient for checking for angina?
ECG and blood test
on the EGC, may be evidence of myocardial infarction such as pathological Q waves and may be evidence of left ventricular hypertrophy (i.e. high voltages, lateral ST segment depression or ‘strain pattern’
what is a specialised test we use for angina?
exercise tolerance test (ETT)
describe myocardial perfusion imaging?
Radionuclide tracer injected (iv) at peak stress on one occasion, images obtained; and at rest on another
so compares images at rest to stress
Tracer seen at rest but not after stress = ischaemia
Tracer seen neither rest, or after stress = infarction
describe myocardial perfusion imaging?
Radionuclide tracer injected (iv) at peak stress on one occasion, images obtained; and at rest on another
so compares images at rest to stress
Tracer seen at rest but not after stress = ischaemia
Tracer seen neither rest, or after stress = infarction
useful for figuring what part of the heart is going wrong
what are the 3 treatment strategies for stable angina?
General measures - Address ASCVD risk factors: BP, DM, Cholesterol, Lifestyle: physical activity & smoking.
Medical treatment - Drugs to reduce disease progression & symptoms
Revascularisation (if symptoms not controlled) - Percutaneous coronary intervention (PCI) & coronary artery bypass grafting (CABG
