What are the 2 main causes of angina, and what conditions underlie these causes?
1) decrease in myocardia O2 supply due to:
coronary artery disease (atherosclerosis, spasm, post radiation therapy), severe anaemia -> ischaemia
2) increase in myocardial O2 demand due to:
L. ventricular hypertrophy (hypertension, aortic stenosis/regurgitation, hypertrophic cardiomyopathy), R. ventricular hypertrophy (pulmonary hypertension/stenosis), rapid tachyarrhythmias (typically AF)
Bold = most common
What are the 5 indications for specialist cardiological referral?
1) new onset angina
2) exclusion of angina in high risk individuals with atypical symptoms e.g. hyperlipidaemia
3) worsening angina in pt with previously stable symptoms
4) new/recurrant angina in pt with history of MI/coronary revascularisation (bypass/angioplaty)
5. assessment of occupational fitness (e.g. airline pilots)
What is the first diagnosis process for angina?
What is the second diagnosis process for angina?
character, location, radiation (e.g. throat, jaw, arm), duration (if all day, not angina), provocation (angina provoked by exertion, sometimes stress)0
Second: Noninvasive investigation = exercise ECG
What is the 4 step process of ischaemia testing for coronary artery disease?
1. Perfusion abnormality = perfusion imaging
2. Regional diastolic and systolic dysfunction = LV wall motion analysis
3. Global LV dysfunction and ischaemic ST depression = eletrocardiography
4. Angina = clinical assessment
What might you see in an exercise ECG for angina:
a) diagnostic features?
b) prognostic features?
What kinds of imaging can be used for angina diagnosis?
a) planar or down-sloping ST depression
b) poor exercise tolerence, severe/early ST depression, exertional arrhythmia/hypertension
BUT NOT V. GOOD TEST: false +ve/-ves
Functional imaging: isotope/MR perfusion imaging, dobutamine stress echo
Anatomical imaging: CT calcium scoring and angiography
Does stenting for angina prolong life?
What are the 2 types of CABG?
What should you consider before CABG?
No but does help angina.
Bypass using internal mammary artery (for LAD) or saphenous vein (for RCA)
Coronary anatomy, pt choice, proceedural risk (death, stroke, AMI), symptomatic benefit, repeat revasc, prognostic benefit