CVS Angina Pectoris Flashcards Preview

Cardio > CVS Angina Pectoris > Flashcards

Flashcards in CVS Angina Pectoris Deck (23):
1

Pathophysiology

Atherosclerosis - MI Mostly atheroma Anaemia AS Tachyarrythmias Arteritis

2

Risk Factors - modifiable

HTN DM SMoking Increased cholesterol Obesity

3

Risk Factors non modifiable

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

4

Symptoms

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

5

Precipitating factors

Emotion Cold weather Heavy meals

6

Classification

Stable Unstable Decubitus Prinzmetal's/variant Syndrome X

7

Stable

induced by effort

8

Unstable

Occurs at rest/ minimal exertion

9

Decubitus

induced by lying down

10

Prinzmetals/variant

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

11

Treatment of prinzmetals

CCB and long-acting nitrate

12

Syndrome X

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

13

Differentials for angina

AS Aortic aneurysm GI: GORD, spasm Musculoskeletal

14

Investigations

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

Management

Lifestyle Medical Interventional Surgical

16

Lifestyle

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

17

Medical secondary prevention

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

18

Anti-anginals - preventing episodes

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

19

Interventional: PCI indecations

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

20

Interventional PCI complications

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

21

Reducing the risk of re-stenosis

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

22

Surigcal: CABG indications

L main stem disease Triple vessel disease REfractory angina Unsuccessful angioplasty

23

Complications of CABG

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

Decks in Cardio Class (108):