Stable Angina Flashcards
ESSENCE
Narrowing of coronary arteries reducing blood flow to myocardium, during times of high demand such as exercise there is insufficient supply of blood to meet demand
When is angina stable or unstable
Stable - symptoms relieved by rest of GTN
Unstable - symptoms come on randomly at rest
CLINICAL FEATURES
Presentation
- Chest pressure lasting several minutes
- Provoked by exercise or emotional stress
- Relieved by rest or GTN
- Normal examination
INVESTIGATIONS
Gold standard
CT coronary angiography
INVESTIGATIONS
First line
- Resting ECG
- Haemoglobin
- Lipid profile
- Fasting blood glucose or HbA1c
MANAGEMENT
Principles
- RAMP
- Refer to cardiology
- Advice about diagnosis, management and when to call ambulance
- Medical treatment
- Procedural or surgical interventions
MANAGEMENT
Medical management aims
- Immediate symptomatic relief
- Long term symptomatic relief
- Secondary prevention of CVD
MANAGEMENT
Medical - immediate symptomatic relief
- GTN spray
- Take dose, wait 5 mins, repeat. if pain 5 mins after this call ambulance
MANAGEMENT
Medical - long term symptomatic relief lines
- 1) Beta blocker (eg bisoprolol)
- 2) Calcium channel blocker (eg amlodipine)
MANAGEMENT
Medical - secondary prevention
- Aspirin (75mg once daily)
- Atovastatin
- ACE inhibitor
- Beta-blocker
MANAGEMENT
Surgical interventions
- Percutaneous coronary intervention (PCI) with coronary angioplasty
- Coronary artery bypass graft (CABG)
MANAGEMENT
What is CABG
Surgery, opening along sternum with midline sternotomy scar, taking graft vein from patients leg (great sephanous) and sweing it on to affected coronary artery to bypass stenosis
MANAGEMENT
What is PCI
Dilating blood vessel with balloon and/or inserting stent
Inserted using catheter into patients brachial or femoral artery and feeding up to coronary arteries under xray guidance
COMPLICATIONS
- Ishcaemic cardiomyopathy/heart failure
- Myocardial infarction
- Sudden cardiac death
- Stroke
- Peripheral arterial disease
