chronic coronary syndrome Flashcards
(44 cards)
coronary artery syndrome overview
spectrum of conditions resulting from reduced blood flow in the coronary arteries - usually caused by atherosclerosis
broadly divided into acute coronary syndromes and chronic coronary syndromes
name the coronary artery diseases
CHRONIC CORONARY SYNDROME
- stable angina
- asymptomatic CAD
- ANOCA - angina with non-obstructive coronary artery disease
ACUTE CORONARY SYNDROME
- unstable angina
- MI - NSTEMI, STEMI, MINOCA
modifiable risk factors - chronic coronary syndrome
Smoking
Hypertension
Diabetes
Dyslipidaemia
Inactivity
Obesity (and diet)
non-modifiable risk factors - chronic coronary syndrome
Male sex
Age
Family history
Personal history
Kidney disease
explain what effect exercise and rest has on angina
in healthy people cardiac oxygen demand = cardiac oxygen supply
in angina cardiac oxygen demand>cardiac oxygen supply
name 5 aggravating factors for chronic coronary syndrome
anything that increases cardiac supply:
Anaemia
Hypoxemia
Hypothermia
Hypovolaemia
anything that teaches cardiac demand:
Hypertension
Tachyarrhythmia
Valvular heart disease
Hyperthyroidism
Hypertrophic cardiomyopathy
Cold weather
Heavy meals
Emotional stress
chronic coronary disease prognosis
Prognosis depends heavily on other factors
smoking angina ect
symptoms and presentation of CCS
CHEST PAIN
strangling
constricting
squeezing
pressure
heaviness
LOCATION
retrosternal
extends to L arm and jugular
fist size
DURATION
short - triggered by exersize or emotion
TRIGGER
cold weather, strong winds
heavy meal
emotional distress
RELIEF
subsiding within 1-5 mins after discontinuation
what tests would you use for CCS which could reveal CAD and IHD and how would these differ
CAD
anatomical tests - characterise coronary plaque - 2 ways:
- invasive angiogram - GOLD standard
- CT coronary angiogram
IHD
use stress conditions to look for ischaemia - assess blood flow and heart function under stress
stress echo
exersize ECG
SPE T
cMRI
PET
prognostic vs symptomatic treatment
prognostic - preventing it from converting into ACS
symptomatic - optimising supply demand mismatch
prognostic treatment
lipid modification:
statins
ezetimibe - 2nd opt
PCSK9 inhibitors
target for LDL <1.4 and 50%+ reduction
lifestyle and risk factor management:
antiplatelet therapy - for blocked arteries:
aspirin
clopidogrel
revascularisation - restoring blood flow:
- angioplasty and stents
- bypass surgery
Treatment: symptomatic
calcium channel blockers:
beta-blockers
nitrates
potassium channel blockers
ivabradine
slows SAN - red HR
ranolazine
inhibits Na current - less Ca - less contraction
Coronary Artery Bypass Grafting (CABG) overview
a surgical procedure used to treat severe coronary artery disease, particularly when blockages are extensive
ANOCA /INOCA
Angina/ischaemia with non-obstructive coronary arteries
mainly women
Can be caused by diseases that affect the microvessels
diagnosis of exclusion
No specific treatments but treated with std antianginals and risk factor modification
stable angina go to medication
- short acting nitrate
- 75mg daily of aspirin
- ACE inhibitors
- statin
name the main chronic coronary syndromes
stable angina
asymptomatic
ANOCA
Advantages and drawbacks to exercise testing (2)
Good functional test
Relies on patients ability to walk on a treadmill (useless for elederly, obese, arthritis etc)
Advantages and limitations of CT angiography (fuzzier than normal angiography) (3)
Good diagnostic test and at spotting severe disease
Not so good at moderate disease
Anatomical, not functional
Fibrous cap in stable angina?
Fibrous cap is strong and less rupture prone
Contraindication for beta blockers?
Asthma- do not give
How to assess chest pain? (OPQRST, 9)
Onset
Position (site)
Quality (nature/character)
Relationship (with exertion, posture, meals, breathing and with other symptoms)
Radiation
Relieving or aggravating factors
Severity
Timing
Treatment
Four types of angina?
- Stable - normal three point definition
- Unstable - pain at rest, not relieved by inactivity or GTN spray + no ECG CHANGES
- Prinzmetal’s - due to coronary vasospasm (not due to cv vessel atherogenesis)
Seen increasingly in cocaine users
ECG shows ST elevation - Decubitus - induced when lying flat (usually complication of cardiac failure)
How to diagnose stable angina? (2)
1st line= ECG- resting and with exercise (to induce ischaemia)
Coronary angiography- looks for stenoses and atherosclerotic arteries (~70-80% occluded)
Gold standard but invasive so not first line
Reasons for imperfect blood supply to the heart? (7)
- Atherosclerosis
- Thrombosis
- Thromboemboli
- Artery spasm
- collateral blood vessels
- blood pressure/ cardiac output/ heart rate
- Arteritis
