Flashcards in Angina Deck (12)
What are the two groups of common causes of angina?
Decreased myocardial oxygen supply or increased myocardial oxygen demand
What may cause decreased myocardial oxygen supply leading to angina?
Coronary artery disease or severe anaemia
What may cause increased myocardial oxygen demand leading to angina?
Left ventricular hypertrophy (deu to hypertension, aortic valve dysfunction), right ventricular hypertrophy (due to pulmonary hypertension or pulmonary valve stenosis) or rapid tachyarrhythmias
How may angina appear on ECG?
There may be a planar or down-sloping ST depression
What treatments may be given to increase oxygen supply to the myocardium in angina?
Nitrates, calcium channel blockers, nicorandil (all vasodilators) or revascularisation
What treatments may be given to decrease oxygen demand to the myocardium in angina?
Reduce heart rate - beta blockers and ivabridine
Decreased tension of left ventricular wall - beta blockers, nitrates, nicorandil, calciumm channel blockers and ranolazine
Reduced heart contractility - beta blockers and calcium channel blockers
Modify energy metabolism - trimetazidine
What are the two different mechanisms of coronary revascularisation surgery?
Percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)
Describe percutaneous coronary intervention (PCI)
Involves the insertion of a stent in order to improve blood flow and prevent ischaemia, and this is most cost-effective over CABG
Describe coronary artery bypass graft (CABG)
This involves creating a bypass around the blockage using a different artery, such as the internal mammary artery
What treatments are given as secondary prevention with angina?
• Aspirin is given to all patients with angina as prophylaxis
• Statins are given to all patients with angina to lower cholesterol levels
• ACE-I is given to patients with angina only if there are other indications
• Clopidogrel –is given to all patients after PCI or if they are intolerant to aspirin
• Glyceryl trinitrate spray in preventing angina attacks (spray in mouth)
When is clopidrogrel prescribed?
After PCI and if the patients are contraindicated for aspirin. This is an anticoagulant which prevents further clot formation