SIHD and Angina Flashcards
(67 cards)
what does SIHD stand for
stable ischemic heart disease
what are the 3 golden things to remember about angina
stable angina comes on almost exclusively on exertion
stable angina more common in people with high CV risk
treatment is symptomatic (treating the symptoms - felling better), However disease modification effects prognosis
what is the definition of angina
literally pain - but adopted to mean chest pain (myocardial ischemia without necrosis)
what causes the chest pain (myocardial ischemia)
a mis-match between O2 supply and demand
what are causes of stable angina (remember - myocardial ischemia) - how common are they
obstructive coronary atheroma CORONARY STENOSIS - v. common
coronary artery spasm - uncommon
coronary inflammation/ arteritis - v. rare
Anaemia - have to be very severally anaemic
or due LVH (left ventricular hypertrophy) and having a lack of O2 to supply it
when does myocardial O2 demand increase - increased HR and BP
exercise, cold weather, anxiety/emotional and after a large meal
how is angina diagnosed
by the HISTORY
what should be red flags for angina in the history
S - site - retrosternal (front of chest)
O - onset - exertion
C - character - tight band, pressure
R - radiation - chest mainly, maybe down the left arm
what happens to someone with angina when they rest or take GTN
a rapid improvement in the chest pain/ tightness
what are the nonmodifiable risk factors for angina
old age, male, family history, genetic factors
what are the modifiable risk factors for angina
smoking
lifestyle - exercise and diet
control of conditions
diabetes mellitus
hypertension
hyperlipidaemia
what is GTN
a smooth muscle dilator
what must you always do to people with chest pain
you must examine people with chest pain to rule out more sever conditions
what is a fairly useful test for finding the underlying cause of the angina
full blood count and lipid profile
what are the 3 main ways to test and confirm it is angina
reproduce symptoms - exercise test - ST depression
demonstrate ischemia
demonstrated dysfunction
both done by CT scan or invasive angiogram (can lead to thrombus)
what are the 3 effects of the treatments
disease modification to improve prognosis
treating the symptoms
surgery
what are the 3 treatment strategies
addressing risk factors
medicines
revascularisation - surgery
when is revascularisation (surgery) undertaken
when the symptoms are not controlled
what medicines influence disease progression - when would they be used
statins - if high cholesterol
ACE inhibitors - if high CV risk and atheroma
aspirin - protects epithelium - put on in genera
what medicines can be used for symptom relief
beta blockers
nitrates - GTN - vasodilation
Ca2+ channel blockers - vasodilation
in relation to angina what would statins be used for
reduce LDL cholesterol deposition in atheroma
stabilise atheroma
and can lead to stabilisation/ regression
Disease mod
in relation to angina what would ACE inhibitors be used for
lowers B
if increased CV risk and atheroma
stabilises endothelium and also reduces plaque rupture
in relation to angina what would aspirin be used for
may not directly effect plaque
but stops platelet aggregation
protects endothelium
in relation to angina what would beta blockers be used for
Reduced myocardial work and have anti-arrhythmic effects
