Stable angia

Question 1

What is the most common cause on aginal symptoms ?

Answer 1

Obstructive coronary disease

Question 2

What is an uncommon cause of anginal symptoms?

Answer 2

Coronary artery spasm

Question 3

What is a very rare cause of anginal symptoms?

Answer 3

Coronary inflammation

Question 4

What condition of the blood can cause angina?

Answer 4

Anaemia

Question 5

What can cause angina symptoms but is uncommon?

Answer 5

• LVH

- Throtoxicosis

Question 6

What cause left ventricular hypertrophy?

Answer 6

Persistent hypertension

• Sig stenoisis of aorta
• Hypertrophic cardiomyopathy

Question 7

What happens when exercising with stable angina?

Answer 7

• Increased myocardial oxygen demand

- Obstructed coronary flow leads to myocardial ischaemia and then the symptoms of angina

Question 8

What can cause excess myocardial oxygen demand?

Answer 8

• Exertion
• cold wheather
• emotional stress

Question 9

What causes acute coronary syndromes?

Answer 9

Spontaneous plaque

rupture & local thrombosis, with degrees of occlusion

Question 10

Where is site of pain for angina?

Answer 10

Rertosternal

Question 11

What is the character of pain with stable angina?

Answer 11

Tight band pressure

Question 12

Where does angina pain radiate to?

Answer 12

neck/jaw/down arms

Question 13

What would other symptoms of stable angina be without chest pain?

Answer 13

• Breathless on exertion
• Excessive fatigue on exertion
• Near syncope on exertion

Question 14

What is class 1 angina?

Answer 14

Ordinary physical activity does not cause angina, symptoms only on significant exertion

Question 15

What is class 2 angina?

Answer 15

Slight limitation of ordinary activity, symptoms on walking 2 bloacks or > 1 flight of stairs

Question 16

What is class 3 angina?

Answer 16

Marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs

Question 17

What is class 4 angina?

Answer 17

Symptoms on any activity, getting washed/dressed causes symptoms

Question 18

What can be found on examining a patient with stable angina?

Answer 18

• Tar staining
• Obesity
• Xanthalasma and corneal arcus
• Hypertension
• Abdominal aortic aneurysm arterial bruits, absent or reduced peripheral pulses
• Diabetic retinopathy

Question 19

How do you discover hypertensive retinopathy?

Answer 19

Fundoscopy

Question 20

What are the signs of exacerbating or associated conditions?

Answer 20

• Pallor of anaemia
• Tachycardia,trmor, hyper-reflexia of hyperthyroidism
• Ejection of systolic murmur, plateau pulse of aortic stenosis
• Signs of heart failure?

Question 21

What are the signs of heart failure?

Answer 21

basal crackles, elevated JVP

Peripheral oedema

Question 22

What does an ecg show for stable angina?

Answer 22

Normal in over 50% of cases

Question 23

What can be found incidentally on ECG with stable angina?

Answer 23

Evidence of prior myocardial infarction (ie Pathological Q-waves)

Question 24

What shows evidence of left ventricular hypertrophy?

Answer 24

high voltages

lateral ST-segment depression or “Strain pattern”

Question 25

What is the test for diagnosis stable angina?

Answer 25

Exercise tolerance test

Question 26

What is needed for a diagnosis?

Answer 26

A positive ECG ( ST-segment depression) AND typical symptoms

Question 27

Does ETT rule out significant coronary atheroma?

Answer 27

NO- but if negative at high workload overall prognosis is good.

Question 28

What does a stint do?

Answer 28

dilates all the blood vessels

Question 29

What is the use of myocardial perfusion imaging?

Answer 29

Detection of CAD Localisation of ischaemia Assessing size of affected areas

Question 30

What drugs can be given to simulate exercise?

Answer 30

Adenosine, | dipyridamole/ dobutamine

Question 31

What would you diagnose if tracer is seen at rest but not after stress

Answer 31

-Ischaemia

Question 32

Tracer seen neither at rest or stress

Answer 32

-Infarction

Question 33

When would you preform invasive angiography?

Answer 33

- Early or strongly positive ETT - Angina refractory to medical therapy - Diagnosis not clear after after non-invasive tests - Young cardiac patients due to work/life effects - Occupation or lifestyle with risk?

Question 34

How does a cardiac catheterisation get to cornoary arteries?

Answer 34

-Cannula inserted into femoral or radial artery | passed to aortic root and introduced into the ostium of coronary arteries

Question 35

What are the three stages of treatment of stable angina?

Answer 35

- General measures - Medical treatment - Revascularisation

Question 36

What general measures can be taken to reduce angina?

Answer 36

BP Diabetes mellitus Cholesterol Lifestyle

Question 37

When is re vascularisation used?

Answer 37

-If symptoms are not controlled

Question 38

What does PCI stand for?

Answer 38

Percutaneous coronary intervention

Question 39

What does CABG stand for?

Answer 39

Coronary artery bypass grafting

Question 40

When should statins be considered?

Answer 40

Considered >3.5 mmol/l

Question 41

What do statins do?

Answer 41

reduce LDL-cholesterol depostion in atheroma and also stabilis atheroma reducing plaque rupture

Question 42

What do ACE inhibitors do?

Answer 42

stabilise endothelium and also reduce plaque rupture

Question 43

What does aspirin do?

Answer 43

may not directly affect plaque but does protect endothelium and reduces of platelet activation/aggregation

Question 44

What would you prescribe to someone who is allergic to aspirin?

Answer 44

Clopidogrel

Question 45

What is the dose of aspirin normally prescribed?

Answer 45

75mg

Question 46

What is given for relief of symptoms?

Answer 46

- B-Blockers - Ca2+ channel blockers - IK channel blockers

Question 47

-Beta-blockers are used to achieve what?

Answer 47

<60bpm

Question 48

\What do beta blockers do?

Answer 48

reduce myocardial work and have anti-arrhythmic effects

Question 49

What do calcium channel blockers do?

Answer 49

Central acting

Question 50

What are the names of some Ca2+ blockers

Answer 50

ditiazem/verapamil

Question 51

Name a IK channel blocker?

Answer 51

Ivabridine is a new medication which reduces sinus node rate

Question 52

What calcium channel blockers produce vasodilation?

Answer 52

peripheral acting dihydropyridines Eg: Amlodipine felodipine

Question 53

What nitrates produce vasodilation?

Answer 53

GTN

Question 54

Name a K+ channel blocker?

Answer 54

nicorandril

Question 55

What does PCI?

Answer 55

percutaneous coronary intervention

Question 56

What does PTCA?

Answer 56

percutaneous transluminal cornary angioplasty

Question 57

Whats the difference between PCI and PTCA?

Answer 57

Start the same | but crosses stenoitic lesion with guidewire and squash atheromatous plaques into walls with ballons and stent

Question 58

What happens if stent is used in PTCA?

Answer 58

aspirin and clopidogrel taken togetherwhilst endothelium covers the stent struts and it is no longer seen as a foreign body with risk of thrombosis

Question 59

Will PCI improve prognosis?

Answer 59

no evidence of this

Question 60

What does CABG stand for?

Answer 60

Coronary artery bypass surgery