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BRS 1b > Angina > Flashcards

Angina Flashcards

1
Q

What is angina?

A

Angina describes a condition marked by severe pain in the chest, characteristically radiating to the shoulders, arms and neck - due to inadequate supply to the heart

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2
Q

Where does angina-like pain typically radiate to?

A

To the shoulders, arms and neck

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3
Q

What is IHD?

A

Ischaemic heart disease is an inability to adequately perfuse the myocardium, predominantly caused by atherosclerosis of the epicardial coronary arteries.

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4
Q

What features are associated with typical angina?

A
  • Precipitated by physical exertion or emotional stress
  • Chest pressure or squeezing lasting several minutes
  • Relived by rest of glyceryl trinitrate (GTN) within 5 minutes.
  • Constricting discomfort in the front of the chest, in the neck, shoulders, jaw or arms.
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5
Q

For patients with typical angina, the administration of sublingual GTN, will have what effect?

A

Relief within 5 minutes

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6
Q

What are the triggers for typical angina?

A

Precipitated by physical exertion or emotional stress.

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7
Q

What additional features are associated with atypical angina?

A

Presents with two features found in typical angina, in addition to atypical symptoms including gastrointestinal discomfort and/or breathlessness and/or nausea

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8
Q

What factors make stable angina less likely?

A

Pain that is continuous or prolonged
Pain that is unrelated to activity
Pain that is brought on by breathing
Pain that is associated with dizziness, palpitations, tingling or difficulty swallowing

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9
Q

What are the classifications for stable angina?

A

The pain or discomfort upon physical exertion to which the demands on the heart have increased

Occurs for a short period of time (<5 minutes)

Relieved by rest of GTN

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10
Q

How is stable angina relieved?

A

Sublingual GTN

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11
Q

Describe the period in which a stable angina presents?

A

For a short period of time <5 minutes

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12
Q

What is an unstable angina?

A

Occurs when individual is resting, persisting longer than stable angina

Rest or medicine does not alleviate the angina,

Progressively worsen over time –> MI

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13
Q

What is a prinzmetal angina?

A

The pain from variant angina is caused by a spasm in the coronary arteries caused by exposure to cold, smoking or stress

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14
Q

What type of angina is caused due to a vasospasm?

A

Prinzmetal angina

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15
Q

What investigations are considered in patients presenting with angina?

A

ECG
Coronary angiography
Exercise tolerance test
Lab tests (Complete blood profile, lipids, renal test, liver function tests, cardiac enzymes)

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16
Q

What cardiac enzyme is typically elevated in a patient with an MI/ released in response to cardiac damage?

A

Troponin

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17
Q

If troponin levels are normal in patients presenting with angina, what is indicated?

A

Suggestive that the symptoms and chest pain are attributed to cardiac muscle damage, and more likely that the pain is due to stable angina.

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18
Q

What other cardiac biomarkers are elevated in patients presenting with angina?

A

Myoglobin
CK-MB
BNP

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19
Q

What is the short-term management for patients presenting with angina?

A

Short-acting nitrate - Sublingual GTN

Beta-blockers or calcium channel blockers (amlodopine)

20
Q

A patient with an ST-segment elevation in leads I, AvL and V6, alongside reciprocal changes in leads III and AvF will manifest as what type of STEMI?

A

Lateral STEMI

21
Q

Which coronary artery is linked to a lateral STEMI?

A

Left circumflex

Diagonal D1 artery of the LAD

22
Q

Which leads have an ST elevation in an anterior STEMI?

A

V1, V2, V3 and V4

23
Q

Which coronary artery is associated with an anterior STEMI?

A

Left coronary artery

Left anterior descending artery (LAD)

24
Q

What reciprocal changes are evident in an anterior view STEMI?

A

None

25
Q

What ST-elevations are -present in a lateral view STEMI?

A

I, AvL, V5, V6

26
Q

What reciprocal changes are seen in patients with a lateral STEMI?

A

Leads III, AvF

27
Q

Which leads are concerned with ST-elevations in an inferior view STEMI?

A

II, III, AvF

28
Q

Which artery is involved with an inferior view STEMI?

A

Right coronary artery

29
Q

What reciprocal changes are evident in an inferior view STEMI?

A

Leads I, and AvL

30
Q

Which leads have ST-Elevation in a posterior view STEMI?

A

V7-9

31
Q

Which coronary artery is associated with a posterior view STEMI?

A

Right coronary artery

32
Q

ST elevations in leads V7,. V8 and V9, are associated with which view?

A

Posterior view

33
Q

Which leads are linked with a septal view of the heart?

A

Leads V1 and V2

34
Q

What immediate drug is prescribed to patients with a STEMI?

A

Loading dose of 500mg Aspirin (Antiplatelet and add-on anti-ischaemic drug/anticoagulation)

35
Q

In a patient with a STEMI, what intervention is recommended for re-perfusion therapy?

A

A PCI

36
Q

What is the alternative to a PCI?

A

Thrombolysis or rescue PCI or CABG

37
Q

What is the long-term management for patients with an STEMI?

A

Anti-platelet therapy, statin, beta-blocker, ACE inhibitor, cardiac rehabilitation, and lifestyle changes

38
Q

What is the biggest risk with a STEMI?

A

Thrombosis and cardiac failure

39
Q

Angina that is not relieved by rest, is most likely to be what?

A

Unstable Angina /NSTEMI

40
Q

What is an NSTEMI?

A

There is an incomplete thrombus formation. This does not completely obstruct blood and oxygen; however, the partial restriction is significant to the extent that oxygen is depleted rapidly.
• Tissue necrosis occurs in the distal arteries and arterioles as a product of oxygen starvation.
• Small, affected area  Insufficient to cause ST-elevation
• Troponin elevation

41
Q

In terms of thrombus formation, what happens in an NSTEMI?

A

Incomplete thrombus formation, there is partial obstruction of the coronary arteries

42
Q

Why is there not ST-elevation in an STEMI?

A

There is partial occlusion, thus this is insufficient to cause ST-elevation

43
Q

What is unstable Angina?

A

The plaque becomes unstable, and the fibrous cap is disrupted, thrombus is formed

There is a sufficient luminal diameter to satisfy the demand during rest

44
Q

What is the main difference between an NSTEMI and unstable angina?

A

Troponin is elevated in a NSTEMI?

45
Q

In a patient with positive troponin NSTEMI, what is the recommended management?

A

Invasive mangement:

CA, CABG, PCI

46
Q

What is the recommended management for a patient with a low risk NSTEMI/unstable angina?

A

Conservative management (Sublingual GTN for symptom relief)

Stress test - if positive considering invasive

BRS 1b (62 decks)

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