[angina pectoris] Flashcards
(57 cards)
1
Q
A
myocardial ischaemia due to atheroma
2
Q
A
aortic stenosis small vessel disease anaemia tachyarrythmias hypertrophic cardiomyopathy
3
Q
A
Cardiac syndrome X
4
Q
A
brought on by exercise
relieved by rest
5
Q
A
arm (both)
neck
jaw
teeth
6
Q
A
dyspnoea
faintness
sweatiness
nausea
7
Q
A
at rest
increasing severity angina (crescendo)
8
Q
A
angina associated with lying flat
9
Q
A
angina due to coronary artery spasm
10
Q
A
Prinzmetal’s angina
11
Q
A
anyone! usually those with no risk factors for atherosclerosis
12
Q
A
at rest
13
Q
A
elevated ST segment
which resolves when the pain subsides
14
Q
A
aspirin (aggravate the attack) beta blockers (increase vasospasm)
15
Q
A
calcium channel blockers
long-acting nitrates
16
Q
A
MRI
myocardial perfusion scintigraphy
stress echo
17
Q
A
echocardiogram done after supervised exercise
18
Q
A
known CAD (coronary artery disease) typical pain
19
Q
A
none assume stable angina (ECG already performed)
20
Q
A
exercise testing
functional imaging
21
Q
A
age
typical/atypical/non-anginal pain
low/high risk
22
Q
A
hyperlipidaemia
diabetes
smoking
23
Q
A
35
45
55
65
24
Q
A
reconsider CAD as a Dx
25
[angina pectoris]: Ix: 10-29% liklihood of CAD means that your 1st line Ix (after ECG) will be ...
CT scan to determine coronary artery calcification score
26
[angina pectoris]: Ix: what is a coronary artery calcification score
Calcification of coronary arteries is a sign of atherosclerotic disease and can be quantified using
multislice computed tomography
27
[angina pectoris]: Ix: 30-60% liklihood of CAD means that your 1st line Ix (after ECG) will be ...
functional imaging
(MRI
myocardial perfusion scintigraphy
stress echo)
28
[angina pectoris]: Ix: 61-90% liklihood of CAD means that your 1st line Ix (after ECG) will be ...
angiography
or
functional imaging
29
[angina pectoris]: Ix: greater than 90% liklihood of CAD means that your 1st line Ix (after ECG) will be ...
assume CAD present
30
[angina pectoris]: Ix: what constitutes hyperlipidaemia
greater than 6.7 mmol/L
31
[angina pectoris]: Ix: when can you assume CADs in men
>70 years
| either typical OR atypical pain
32
[angina pectoris]: Ix: when should you assume CADs in women?
>70
High risk
typical symptoms
33
[angina pectoris]: Ix: in women >70 years what CAD risk is assumed
61-90%
34
[angina pectoris]: Ix: what is the 1st line Ix regardless of CAD score/
ECG
35
[angina pectoris]: Ix: what 5 precipitating causes should you exclude
```
Diabetes
Hyperlipidaemia
thyrotoxicosis
anaemia
temporal arteritis (GCA)
```
36
[angina pectoris]: Ix: what is one of hyperthyroidisms major complications?
thyrotoxicosis
37
[angina pectoris]: Ix: what may be seen on ECG (apart from normality which is usual)
depressed ST segment
| flat/inverted T waves
38
[angina pectoris]: Ix: above what level must total cholesterol be to indicate statin use
>4mmol/L
39
[angina pectoris]: Ix: what type of angina requires admission and urgent Tx?
unstable
40
[angina pectoris]: Mx: what are the modifiable risk factors which require Mx? (6)
```
Smoking
weight
exercise (wt. loss only beneficial if exercise maintained)
hypertension
diabetes
cholesterol
```
41
[angina pectoris]: Mx: what are the 5 categories of drugs which can be given
```
b-blockers
calcium antagonists - long acting
nitrates
K+ channel activator
Aspirin
```
42
[angina pectoris]: Mx: what dose of aspirin should be given
75-150mg/24hrs
reduced mortality by 34%
43
[angina pectoris]: Mx: what are the 2 first line Txs?
lifestyle advice
| aspirin
44
[angina pectoris]: Mx: name 2 antiplatelet drugs (2)
aspirin
| clopidogrel
45
[angina pectoris]: Mx: what gives symptomatic relief in acute anginal attacks
nitrates
| GTN spray/sub-lingual tablets
46
[angina pectoris]: Mx: what can be adjunct treatment to the 1st line Mx?
b-blockers
metoprolol: 50-200 mg orally
47
[angina pectoris]: Mx: in what circumstances are b-clockers CI'd
```
asthma (absolute!)
COPD
LVF
bradycardia
coronary artery spasm (variant/prinzmetal)
```
48
[angina pectoris]: Mx: when might you use a calcium antagonist
if there is a CI to beta blockers
49
[angina pectoris]: Mx: name 2 calcium channel blockers
amlodipine 10mg/24hrs
| diltiazem
50
[angina pectoris]: Mx: what is the order in which step wise Tx is given (5)
```
lifestyle + aspirin
b-blocker
nitrates
calcium antagonists
K+ channel activator
```
51
[angina pectoris]: Mx: what calcium channel blocker can be used if still uncontrolled
nicorandil 10mg/24hours
52
[angina pectoris]: Mx: what are the 5 indications for referral
```
Dx uncertainty
new angina of acute onset
unresponsive to drugs
recurrent angina (past MI/CABG)
unstable angina
```
53
[angina pectoris]: Mx: what Tx is indicated in angina which has poor response to medical therapy or if positive stress testing?
PTCA
| percutaneous transluminal coronary angioplasty
54
[angina pectoris]: Mx: what are the 2 surgical interventions which can be used in CAD in general
PTCA
| CABG (increased risk of stroke)
55
[angina pectoris]: Mx: which drug can be used as symptomatic prophylaxis
isosorbide mononitrate 20-40mg PO
56
[angina pectoris]: Mx: why must you have an 8 hour nitrate free period in the treatment regimens
prevent nitrate tolerance
57
[angina pectoris]: broadly speaking what is the pathophysiology in angina (cf. ACS)
angina = imbalance between myocardial O2 demand and supply for any reason inc. thrombus
ACS = thrombus formation ---> occlusion
