What is angina?
A restriction in blood supply (most often talked about in heart but can even occur in the mouth!)
What is abdominal angina?
Post prandial (after eating) abdominal pain
What is ludwig's angina?
A serious infection of the floor of the mouth
What is vincent's angina?
trench mouth and necrotic gum tissue
What is angina tonsillaris?
An inflammation of the tonsils
What is herpangina?
Pharyngeal blisters caused by Coxsackie A virus or echovirus
What is angina pectoris?
Pain localised to the chest
Acute or chronic (on tablets)
What causes angina?
Restricted blood supply = increased metabolite build up = decreased oxygen supply and increased cardiac work
narrowing of the coronary artery (atheroma, thrombus etc.)
vasospasm of the coronary artery (overly reactive vessels and drugs - e.g. cocaine & smoking)
severe anaemia (cannot carry enough oxygen to the heart)
What are the 3 types of angina pectoris?
Chronic stable = exercise induced -> normally take medication
Unstable = sudden rupture of athleroscelrotic plaque -> blocks down stream arteries
Prinzmetal's (angina inversa) = vasospasm = oversensitivity to vasoconstrictors
From which age do athlerosclerotic plaques start to build up from?
10 years old
What are the risk factors for coronary heart disease (8)?
- Family history
- high blood pressure
- High LDL cholestrol & low HDL cholestrol
- Lack of regular exercise
What is coronary heart disease?
Athlerosclerosis in the coronary arteries
(most common cause of death in UK)
Which is more important... having good (LDL) or bad (HDL) lipoproteins or having the right balance of LDL and HDL?
Having the right balance
What happens to the HDL:LDL ratio with age?
Decreases = increased MI risk
What happens to HDL:LDL ratio with statins?
Increases = less MI risk
(although other drugs that increase the ratio )
Does eating fewer saturated fats in your diet increase or decrease your risk for CHD?
Decrease because less obese!
What are the 3 stages of developing atheroma?
- Damage to epithelia
- Cholesterol accumulation = inflammatory response -> produces foam cells
- Foam cell degeneration = increased stiffness of artery wall = shear stress = continued worsening damage
What causes activation of platelets?
- contact with intima matrix (sheds microparticles = attracts monocytes = proliferate & differentiate = phagocytes)
What is a coronary artery bypass graft?
takes a blood vessel from another part of the body
List 3 alternative treatments for surgical treatment of atheroma:
- Rotational bur
- Stent (wire coil)
What diastolic blood pressure is required for someone to be hypertensive?
What are the potential complications of hypertension (6)?
- Stroke (athlerosclerosis)
- kidney disease
- eye disease
- pre-eclampsia (hypertension & protein in urea, swelling of feet, ankles, face & hands, severe headache, vision problems & pain just below ribs -> occurs if problem with placenta)
- erectile dysfunction
What is primary hypertension:
what % of cases does it make up?
What are its two main causes?
- 90-95% cases (essential/idiopathic)
- obesity (BMI>25)
What is secondary hypertension:
what % of cases does it make up?
What are the 4 main causes?
- 10% of cases
- renal/renovascular disease
- endocrine disease (e.g. phaeochomocytoma- tumour of adrenal medulla, cushings syndrome - excess cortisol, acromegaly - excess aldosterone, hypo/hyperthyroidism, pregnancy)
- coarcation of aorta (malformation of aorta)
- iatrogenic (hormonal/oral contraceptive & NSAIDs)
What are the consequences of hypertension?
Hypertrophy of ventricular (esp. left) wall -> muscle has to work harder for long time = increased risk of sudden cardiac death
What does ALLHAT trial stand for?
The antihypertensive and lipid lowering to prevent heart attack trial
why in the ALLHAT trial was the alpha blocker doxazosin discontinued?
There was an excess no. of deaths
In the ALLHAT trial what was discovered about the efficacy of the following drugs:
Thaizide diuretic (chlorthalidone)
ACE inhibitor (lisinopril)
Ca channel blocker (amlodipine)
All of equal efficacy
Which type of diabetes is hypertension often found in conjunction with?
Which % of type II diabetic patients die from cardiovascular disease?