Flashcards in Angina Deck (24):
What is meant by acute coronary syndromes?
Disorders that are casued by problems with the coronary arteries.
From stable angina to MI
What is angina pectoris?
Caused by a mismatch of oxygen demand and supply
Too little supply for the demand
What are the main causes of angina?
Impairment of blood flow due to narrowing of coronary arteries
Increased resistance to blood flow, for example L ventricular hypertrophy
Reduced oxygen carrying capacity of blood, for example Anaemia
What are the risk factors for angina?
What are some environmental exacerbating factors of angina?
Heavy meals: blood diverted to stomach away from heart
Does angina affect men or women more?
How do patients often describe angina?
A tight band, pressure on their chest
What are the symptoms of angina?
What are the types of angina?
Stable: pain on exertion
Unstable: pain at rest
Prinzmetal's: coronary artery spasm which reduces blood flow
Microvascular: affects smaller vessels rather than coronary arteries
Crescendo: a form of unstable angina which changes or worsens
What's the differential diagnosis of chest pain?
MI or angina
Pericarditis or myocarditis
Dissection of aorta
MSK cause: arthritis
Exclude other causes such as anaemia
What is the treatment for stable angina?
Reduce risk factors
Aspirin: thins blood
GTN (glyceryl trinitrate): spray or sublingual tabs
Statin: reduce blood cholesterol
ACE inhibitor: lower BP
Ca channel blocker
K+ channel activator
Ivabradine: reduces heart rate
What risk factors should you attempt to reduce in angina patients?
What should you do if you suspect someone has unstable angina?
Admit them immediately and begin treatment
What does PCI stand for?
Percutaneous Coronary Intervention
What is a PCI?
A surgical procedure that uses a catheter to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by atherosclerosis.
How is a PCI performed?
A catheter is inserted into the blood vessels either in the groin or in the arm.
Using fluoroscopy, the catheter is threaded through the blood vessels to the narrowed coronary artery.
When the tip is in place, a balloon tip covered with a stent is inflated. The balloon tip compresses the plaque and expands the stent.
Once the plaque is compressed and the stent is in place, the balloon is deflated and withdrawn.
The stent stays in the artery, holding it open.
What does CABG stand for?
Coronary Artery Bypass Graft
What is a CABG?
A surgical procedure where you harvest a blood vessel from the leg (great saphenous vein)and use it to divert blood flow around the obstructed coronary artery, so the heart muscles still receive sufficient blood
The purpose is to restore normal blood flow to that partially obstructed coronary artery.
Investigations for angina.
Exercise test: ECG while exercising
Myoview scan: radioactive tracer to view blood flow
CT coronary angiography: looks at perfusion of coronary vessels
Stress echo: looks at heart under strain
Perfusion MRI: radio-opaque tracer to view blood flow
CT calcium scoring: measures the amount of calcified plaque in the arteries
What is a Myoview scan?
Radioactive tracer is injected into blood stream
The heart is stressed, medically or physically
The heart is scanned and parts of the heart with good blood supply will light up
What is a CT coronary angiography?
Measures blood flow around the heart, using an iodine based dye
The dye will show up dark, so blood vessels that are blocked will be obvious as they will appear light
What is a stress echo?
Uses ultrasound & contrast to look at the heart under stress
Patient is given a drug called Dobutamine which increases heart rate.
The heart is viewed while this is happening
What is a perfusion MRI?
Radio-opaque tracer that shows up ischaemic regions of the heart