Flashcards in Angina Deck (20):
What is meant by acute coronary syndromes?
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?
Family history (1st degree relative with MI under 60)
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?
Chest pain, radiates to L arm and jaw
What are the types of angina?
Stable: pain on exertion
Unstable: pain at rest
Prinzmetal's: coronary artery spasm which reduces blood flow
What's the differential diagnosis of chest pain?
ACS or angina
Pericarditis or myocarditis
Dissection of aorta
MSK cause: arthritis, costochondritis
Exclude other causes such as anaemia
What treatment for stable angina?
Reduce risk factors (treat diabetes, HTN, lifestyle)
Low dose aspirin 75mg OD
GTN (glyceryl trinitrate): spray or sublingual tabs
Beta blocker (or if not effective Ca Channel blocker
Statin: reduce blood cholesterol
What risk factors should you attempt to reduce in angina patients?
Stop drinking alcohol
Control hypertension (ACEi, Ca Ch blockers)
Control diabetes (diet, metformin, etc)
What should you do if you suspect someone has unstable angina?
Send to A+E
What does PCI stand for? What is it?
Percutaneous Coronary Intervention
A surgical procedure that uses a catheter and balloon to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by atherosclerosis.
Criteria for having PCI?
Chest pain onset within 12h
PLUS one or more of
ST elevation 2mm or more in 2 consecutive chest leads
St elevation 1mm or more in 2 consecutive limb leads
Dominant R waves
What does CABG stand for? What is a CABG?
Coronary Artery Bypass Graft
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.
1st line: CT coronary angiography: looks at perfusion of coronary vessels
Myoview scan: radioactive tracer to view blood flow
Stress echo: looks at heart under strain
Perfusion MRI: radio-opaque tracer to view blood flow
3rd: invasive coronary angiography
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