CVS Angina Pectoris Flashcards Preview

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Flashcards in CVS Angina Pectoris Deck (23)
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1
Q

Pathophysiology

A

Atherosclerosis - MI Mostly atheroma Anaemia AS Tachyarrythmias Arteritis

2
Q

Risk Factors - modifiable

A

HTN DM SMoking Increased cholesterol Obesity

3
Q

Risk Factors non modifiable

A

Age Mal FH (MI <55 yrs) Genetic e.g. hyperlipidaemia

4
Q

Symptoms

A

Central chest tightness or haeviness Brought on by exertion, relieved by rest May radiate to one/both arms, neck, jaw or teeth

5
Q

Precipitating factors

A

Emotion Cold weather Heavy meals

6
Q

Classification

A

Stable Unstable Decubitus Prinzmetal’s/variant Syndrome X

7
Q

Stable

A

induced by effort

8
Q

Unstable

A

Occurs at rest/ minimal exertion

9
Q

Decubitus

A

induced by lying down

10
Q

Prinzmetals/variant

A

Occurs during rest 1. Due to coronary spasm 2. ST elevation during attack: resolves as pain subsides

11
Q

Treatment of prinzmetals

A

CCB and long-acting nitrate

12
Q

Syndrome X

A

Angina + pain + ST elevation on exercise test but no evidence of coronary atherosclerosis

13
Q

Differentials for angina

A

AS Aortic aneurysm GI: GORD, spasm Musculoskeletal

14
Q

Investigations

A

Bloods: FBC, U and E, lipids, glucose, ESR, TFTs ECG: usually normal (may show ST depression, flat/inverted T waves, past MI Consider excercise ECG Stress echo Perfusion scan CT coronary Calcium store Angiography (gold standard)

15
Q

Management

A

Lifestyle Medical Interventional Surgical

16
Q

Lifestyle

A

Stop smoking Weight loss and increase exercise Healthy diet: oily fish, fruit, veg, reduced

17
Q

Medical secondary prevention

A

Prevent cardiovascular events. 1. Aspirin 75mg OD 2. ACEi (esp. angina + DM) 3. Statins: simvastatin 40mg 4. Antihypertensives

18
Q

Anti-anginals - preventing episodes

A

GTN (spray or SL) + either 1st: Beta blockers e.g. Atenolol 50-100mg OD 2nd: CCB (Verapamil 80mg TDS

19
Q

Interventional: PCI indecations

A

Poor response to medical treatment Refractory angina but not suitable for CABG

20
Q

Interventional PCI complications

A

Re-stenosis (20-30% @ 6mo) Emergency CABG (<0.5%)

21
Q

Reducing the risk of re-stenosis

A

Clopidogrel Bare metal stent: 1mo Drug-eluting (e.g. sirolimus) stent: 1 yr

22
Q

Surigcal: CABG indications

A

L main stem disease Triple vessel disease REfractory angina Unsuccessful angioplasty

23
Q

Complications of CABG

A

MI Stroke Pericardial tamponade o haemothorax Postperfusion syn. Post-op AF Nonunion of sternum Graft stenosis

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