Stable angina Flashcards
What is angina?
A narrowing of the coronary arteries reduces blood flow to the myocardium. During times of high demand there is insufficient blood flow.
What are the typical symptoms of angina?
constricting chest pain with or without radiation to jaw or arms
When is angina stable?
When symptoms are relieved by rest or GTN
When is angina unstable?
When symptoms come on randomly whilst at rest
What is the gold standard diagnostic investigation for angina/
CT coronary angiography
What baseline investigations should patients with suspected angina have?
Physical (heart sounds, signs of heart failure, BMI) ECG FBC (check for anaemia) U&Es (prior to ACEi and other meds) LFTs (prior to statins) Lipid profile TFTs HBA1c
What are the principles to stable angina management?
RAMP Refer to cardiology Advice about diagnosis, management and when to call ambulance Medical treatment Procedural or surgical interventions
What are the three aims of stable angina management?
immediate symptomatic relief
Long term symptomatic relief
secondary prevention of cardiovascular disease
Describe the immediate symptomatic relief for angina
GTN used as required
Take GTN, then repeat after 5 minutes
If still pain after 5 more minutes call an ambulance
What is used for the long term symptomatic relief of angina?
Beta blocker (e.g. bisoprolol 5mg /day) and /or calcium channel blocker (e.g. amlodipine 5mg / day)
What should be used for secondary prevention in angina?
Aspirin (e.g 75mg once daily)
Atorvastatin 80mg once daily
ACE inhibitor
Already on beta-blocker for symptomatic relief
When is PCI offered to angina patients?
patients with proximal or extensive disease
Which patients may coronary artery bypass graft be offered to?
patients with severe stenosis
What scars should be checked for when examining a patient with suspected CVD?
PCI
Brachial/femoral artery access
CABG
Midline sternotomy
Great saphenous vein harvesting
