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Cardiovascular Diseases > Angina > Flashcards

Flashcards in Angina Deck (28):
1

what is it

restricted perfusion of heart due to atherosclerosis

2

what is difference between stable and unstable angina

stable is on exertion
unstable (ACS) is angina of recent onset or worse at rest

3

what is the symptoms

tight, heavy, dull chest pain that passes within few minutes
radiate to left arm, neck, jaw or back
normally following exertion, stress, after meal or cold weather

4

what causes it

atherosclerosis due to hypertension, hyperlipidaemia, smoking, diabetes, age, sex

5

how is it diagnosed

symptoms
ECG
exercise tolerance test
coronary angiography (assess coronary circulation)
myocardial perfusion scinigraphy

6

what is ECG findings

between attacks - may be normal, or pathological Q waves (old MI), LVH/LBBB

during attacks - transient ST depression, t wave inversion

7

what is the treatment

GTN + secondary prevention (aspirin, ACEi and statin)

B blocker or CCB (verapamil) (if symptoms persist then B blocker + amlodipine)

If B blocker and/or CCB contradicted, give long acting nitrate or HCN channel activator or K+ activator

8

what is the mechanism of GTN (nitrate)

releases nitrate which are converted to nitric oxide which activates guanylyl cyclase, increasing cGMP. this cGMP activates PKG which relaxes vascular smooth muscle

The reduced [Ca2+], since more is taken up by SER, decreases MLCK activity and relaxation occurs due to reduced light chain phosphorylation

9

side effects of GTN

headaches, hypotension, syncope, tolerance

10

what is mechanism of aspirin (anti-platelet)

reduces platelet aggregation and arterial thrombosis by activating plasminogen to plasmin, dissolving thrombi

11

what are side effects of aspirin

bronchospasm, GI irritation, GI haemorrhage

12

what is mechanism of ACEI (lisinopril, ramipril, enalapril)

decrease synthesis of angiotensin II, a powerful vasoconstrictor, reducing vascular done (causing vasodilation)

13

what is the side effects of ACEI

dry cough, angiodema, proteinuria, neutropenia, renal failure, hyperkalaemia

14

what is mechanism of statins (atorvastatin, simvastatin, pravastatin)

HMG CoA reductase inhibitors - block cholesterol synthesis in liver. Compensatory mechanism incomplete and reduction of cholesterol in hepatocytes leads to increased LDL receptor expression, increasing clearance from plasma

15

what is side effects of statins

myopathy

16

what is mechanism of B blocker (bisoprolol)

block B-adrenoceptors
lower CO and decrease force of cardiac contraction

17

what are side effects of B blocker

cold hands, fatigue, provocation of asthma, heart failure, conductance block, nightmares

18

what is mechanism of calcium channel blockers (amlodipine, nifedipine, verapamil)

block L type calcium channels, preventing calcium from entering cells, causing relaxation of arteriolar smooth muscle (reduced TPR so BP falls)

19

what is side effects of CCB

dizziness, hypotension, flushing, ankle oedema

20

what is mechanism of long acting nitrate (isosorbide mononitrate)

same as GTN

21

what is mechanism of HCN channel inhibitor (ivabradine)

reduces HR via specific inhibition of funny current

22

what is mechanism of K+ activator (nicrorandil)

potassium channel activator with nitrate component which has arterial and venous vasodilating properties

23

what surgeries can be considered in angina

PCI and CABG

24

what is PCI

dilation of coronary artery using ballon and stent inserted via femoral/radial/brachial artery
patient must be anticoagulated and antiplateleted beforehand

25

what is CABG

left internal thoracic (mammary) cut distally and attached to coronary artery
or saphenous vein used - one end attached to ascending aorta and other to obstructed vessel

26

what are complications of CABG

systemic inflammatory response, AF and persistent neurological abnormalities

27

what is complications of angina

heart attack
stroke
depression

28

how to tell difference between unstable angina and NSTEMI

unstable angina does not have detectible markers