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Flashcards in Angina Deck (24):
1

What is meant by acute coronary syndromes?

Disorders that are casued by problems with the coronary arteries.

From stable angina to MI

2

What is angina pectoris?

Chest pain
Caused by a mismatch of oxygen demand and supply

Too little supply for the demand

3

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

4

What are the risk factors for angina?

Age
Cigarette smoking
Family history
Diabetes mellitus
Hyperlipidaemia
Hypertension
Renal disease
Obesity
Physical inactivity
Stress

5

What are some environmental exacerbating factors of angina?

Cold weather

Heavy meals: blood diverted to stomach away from heart

Emotional stress

6

Does angina affect men or women more?

Men

7

How do patients often describe angina?

A tight band, pressure on their chest

8

What are the symptoms of angina?

Chest pain
Breathlessness
Fluid retention
Palpitations
Syncope

9

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

10

What's the differential diagnosis of chest pain?

MI or angina

Pericarditis or myocarditis

Pulmonary Embolism

Chest infection

Dissection of aorta

Gastro-oesophageal reflux/ulceration

MSK cause: arthritis

Exclude other causes such as anaemia

11

What is the treatment for stable angina?

Reduce risk factors

Aspirin: thins blood

GTN (glyceryl trinitrate): spray or sublingual tabs

Beta blocker

Statin: reduce blood cholesterol

ACE inhibitor: lower BP

Ca channel blocker
K+ channel activator

Ivabradine: reduces heart rate

Revascularisation: PCI/CABG

12

What risk factors should you attempt to reduce in angina patients?

Lose weight
Stop smoking
Exercise more
Reduce cholesterol

Control hypertension
Control diabetes

13

What should you do if you suspect someone has unstable angina?

Admit them immediately and begin treatment

Aspirin
Anti-coagulant
GTN spray
Beta-blockers
etc.

14

What does PCI stand for?

Percutaneous Coronary Intervention

15

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.

16

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.

17

What does CABG stand for?

Coronary Artery Bypass Graft

18

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.

19

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

20

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

21

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

22

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

23

What is a perfusion MRI?

Radio-opaque tracer that shows up ischaemic regions of the heart

24

What is CT scan calcium scoring

CT scan to measure the amount of calcified, or hardened, plaques in the arteries

Given a calcium score of low, moderate or high.