Angina pectoris Flashcards
What is angina pectoris?
Substernal discomfort precipitated by exercise but relieved by rest or GTN spray.
What are the causes of angina pectoris?
Atherosclerosis.
Rarely anaemia and tachyarrhythmia.
What are the precipitates of angina pectoris?
Exercise.
Cold weather.
Heavy meals.
What are the types of angina?
Stable angina: precipitated by exercise but relieved by rest, ST depression.
Unstable angina: pain at rest, worsening symptoms, ST depression.
Decubitus angina: triggered by lying flat, ST depression.
Prinzmetal angina: due to coronary artery spasm, ST elevation.
What investigations should be performed for suspected angina pectoris?
ECG for signs of ST depression or elevation. CT scan. Coronary calcium score (measured on CT). Coronary angiography. Thallium scan.
What are the complications of angina pectoris?
Myocardial infarction.
Stroke.
What is atherosclerosis?
Slowly progressive disease.
Underlying cause of ischaemic heart disease when it occurs in the coronary arteries.
What are the 3 stages of atheroma formation?
Fatty streak formation.
Fibrolipid plaque formation.
Complicated atheroma.
Describe the fatty streak formation as a stage of atheroma formation.
Lipids are deposited in the intimal layer of the artery. This, coupled with vascular injury, causes inflammation, increased permeability and white blood cell recruitment. Macrophages phagocytose the lipid and become foam cells. These form the fatty streak.
Describe the fibrolipid plaque formation as a stage of atheroma formation.
Lipid within the intimal layer stimulates the formation of fibrocollagenous tissue. This eventually causes thinning of the muscular media.
Describe complicated atheroma as a stage of atheroma formation.
This occurs when the plaque is extensive and prone to rupture. The plaque may be calcified due to lipid acquisition of calcium. Rupture activates clot formation and thrombosis. If the coronary artery is partially occluded the result is myocardial ischaemia and therefore angina. If the coronary artery is completely occluded then the result is myocardial necrosis and myocardial infarction.
What is the conservative treatment for angina pectoris?
Modify risk factors, e.g. control cholesterol, control diabetes, smoking cessation advice, weight loss, increase exercise and control hypertension.
What is the medical treatment for angina pectoris?
Nitrates: glyceryl nitrate (GTN) spray, side effects include headache and hypotension.
Aspirin.
Beta-blockers, but contraindicated in asthma and COPD.
Calcium ion antagonists, especially if beta-blockers are contraindicated.
Potassium channel activator, e.g. nicorandil.
What is the surgical treatment for angina pectoris?
Percutaneous transluminal coronary angioplasty or coronary artery bypass graft (CABG).
