Angina Pectoris Flashcards
what is the mechanism of angina?
> 70% narrowing
at rest enough blood can pass
in exercise or stress blood can’t make metabolic demands
ischaemia causes release of adenosine & bradykinin = pain
what is the pathophysiology of angina?
Occurs when there is insufficient oxygen supply to the heart – myocardial ischaemia without infarct
what are the causes of angina?
Narrowing of coronary arteries - Artherosclerosis, Arterial spasm, Blood clot
Rarely: AS, tachyarrhythmias, HCM, ateritis, small vessel disease, aortic valve disease
what are the risk factors for angina?
Hypertension, dyslipidaemia, diabetes, obesity, FHx of arterial disease, smoking, age, male gender
What are the precipitants of angina onset?
Exertion, emotion, cold weather, heavy meals
What are the clinical features of angina?
Central or left chest tightness/heaviness (also arms, neck, jaw, teeth, epigastrium Tight or crushing pain Dyspnoaea Results form exertion, relieved by rest Lasts several minutes
what is crescendo angina?
attacks are increasing in frequency+/- severity = ACS risk
what is stable angina?
induced by effort, relieved by rest
what is unstable angina?
angina of increasing frequency or severity = ACS
what is decubitus angina?
precipitated by lying flat
what is variant angina?
caused by coronary artery spasm, can be transmural
what investigations should be completed?
ECG, CXR, ETT, CTCA, MPS, Echo, angiogram, blood tests
what is the primary diagnostic investigation of angina?
CTCA
what are the main parts of angina management?
Modify risk factors - lifestyle advice
Medications
what is the first line treatment of angina?
o Aspirin
o Beta Blockers
o Nitrates = Symptomatic relief – GTN spray
o Long acting calcium antagonists – amlodipine, diltiazem
