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Flashcards in FN: Angina Deck (21):
1

Pathophysiology

Atherosclerosis → Myocardial ischaemia

2

Aetiology

Mostly atheroma
Anaemia
AS
Tachyarrhythmias
Arteritis

3

Modifiable risk factors

• HTN
• DM
• Smoking
• Increased cholesterol
• Obesity

4

Non-modifiable risk factors

• Age
• Male
• FH (MI <55yrs)
• Genetic: e.g. hyperlipidaemia

5

Symptoms:


• Central chest tightness or heaviness
• Brought on by exertion, relieved by rest
• May radiate to one/both arms, neck, jaw or teeth
• Other ppts: emotion, cold weather, heavy meals

6

Stable

Induced by effort

7

Unstable

Induced by lying down

8

Decubitus

Induced by lying down

9

Prinzmetal’s/variant

Occurs during rest due to:
• Due to coronary spasm
• ST elevation during attack: resolves as pain subsides

10

Treatment

Calcium channel blocker
Long acting nitrate

11

Syndrome X:

Angina pain + ST elevation on exercise test but no evidence of coronary atherosclerosis.
→Probably represents small vessel disease

12

Differential:

1. AS
2. Aortic aneurysm
3. GI: GORD, spasm
4. Musculoskeletal

13

Investigations:

1. Bloods: FBC, U+E, lipids, glucose, ESR, TFTs
2. ECG: usually norml
a. May show ST deression, flat/inverted T waves, past MI
b. Consider exercise ECG
3. Stress echo
4. Perfusion scan
5. CT coronary Ca2_ score
6. Angiography (gold standard)

14

Management medical 2 routes

Prevent cardiovascula events
Antianginals

15

Prevent cardiovascular events

• Aspirin 75mg OD
• ACEi (esp. if angina + DM)
• Statins: simvastatin 40mg
• Anti-hypertensives

16

Antianginals

• GTN (spray or SL) + either
→ 1st beta-blocker (e.g. atenolol 50-100mg OD)
→ 2nd: CCB (e.g. verapamil 80mg TDS)

• If either Beta-blocker of CCB doesn’t control symptoms try the other option
• Can try Beta-blocker + dihydropyridine CCB
e.g. amlodipine MR 10mg/24h

• If symptoms still not controlled
⇒ ISMN 20-40mg BD (8h washout @ PM) slow release nitrate (Imdur 60mg OD)
⇒ Ivabradine (esp.if cant take Beta-blocker)
⇒ Nicorandil 10-30mg BD
⇒ Ranolazine

17

Surgical: CABG indications

⇒ L main stem disease
⇒ Triple vessel disease
⇒ Refractory angina
⇒ Unsuccessful angioplasty

18

CABG complications

⇒ MI
⇒ Stroke
⇒ Pericardial tamponade or haemothorax
⇒ Postperfusion syn.
⇒ Post-op AF
⇒ Nonunion of ternum
⇒ Graft stenosis

19

PCI

⇒ Poor response to medical Rx
⇒ Refractory angina but not suitable for CABG

20

PCI complications

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

21

Clopidogrel reduces

Re-stenosis
⇒ Bare metal stent:1mo
⇒ Drug-eluting (e,g, sirolimus) stent:1yr

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