Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular system SA > Stable angina > Flashcards

Stable angina Flashcards

1
Q

Define stable angina

A

a discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the pathophysiology of of stable angina

A

Common:
reduction in coronary blood flow to the myocardium,

Uncommon:
Reduced O2 transport
e.g. anaemia

increased myocardial O2 demand
e.g. HR and BP rise (exercise, anxiety/emotional stress, cold weather and after a large meal, cold)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are three reasons for reduction in coronary blood flow

A

Obstructive coronary atheroma (Very common)
Coronary artery spasm (Uncommon);
Coronary inflammation/arteritis (Very rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is potentially causes for increased myocardial demand

A

Left ventricle hypertrophy

Hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What propels coronary atheroma to myocardial ischaemia then angina
When would symptoms typically occur

A

activities with the increased myocardial oxygen demand as obstructed coronary blood flow leads to myocardial ischaemia and then the symptoms of angina

When Obstructive plaque >70% lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of angina

A

Typical distribution of pain or discomfort radiating from your chest into your neck and jaw and down your left arm

Tight pressure and heaviness on the chest that aggravated with exertion

Rapid improvement with physical rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What questions allows you to differentiate angina from other pains

A

Site of pain
Character of pain:
Radiation sites
When it was aggravated and how its exasberated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are symptoms that patients that can tell you that make angina the unlikely diagnosis

A

Sharp/‘stabbing’ pain; pleuritic or pericardial.

Associated with body movements or respiration.

Very localised; pinpoint site.

Superficial with/or without tenderness.

No pattern to pain, particularly if often occuring at rest.

Begins some time after exercise.

Lasting for hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the 4 different systems that can cause chest pain

A

Cardiovascular
- Aortic dissection (intra-scapular “tearing”), pericarditis

Respiratory:
-Pleuritic

Musculoskeletal:
- Cervical disease, costochondritis, muscle spasm or strain

GI
- Gastro-oesphageal reflux, oesophageal spasm, peptic ulceration, biliary colic, cholecystitis, pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When myocardial ischaemia occurs with no chest pain what is usually the other symptoms

A

Breathlessness on exertion
Excessive fatigue on exertion for activity undertaken
Near syncope on exertion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What patients is it more common to see myocardial ischaemia with no chest pains but other symptoms in,
what could be the possible reason?

A

elderly or those with diabetes mellitus

probably due to reduced pain sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the different classifications of severity

A

Stage 1:
Ordinary physical activity does not cause angina, symptoms only on significant exertion

Stage 2:
Slight limitation of ordinary activity, symptoms on walking 2 blocks or > 1 flight of stairs

Stage 3:
Marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs

Stage 4:
Symptoms on any activity, getting washed/dressed causes symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the non modifiable risk factors for stable angina

A

Age, gender, creed, family history & genetic factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the modifiable risk factors for stable angina

A

Smoking
Lifestyle- exercise & diet
Diabetes mellitus (glycaemic control reduces CV risk)
Hypertension (BP control reduces CV risk)
Hyperlipidaemia (lowering reduces CV risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What cab be seen on examination that shows signs on that aetiology of stable angina

A

Tar stains on fingers

Obesity (centripedal)

Xanthalasma and corneal arcus (hypercholesterolaemia)

Hypertension,

Abdominal aortic aneurysm arterial abnormal sound,

absent or reduced peripheral pulses.

Diabetic retinopathy, hypertensive retinopathy on eye inspection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In examination what is the signs of exasperation or associated conditions with angina

A

Pallor of anaemia

Tachycardia,

tremor - Co2 retention

over reactive reflexes of hyperthyroidism

Ejection systolic murmur,

plateau pulse of aortic stenosis

Pansystolic murmur of mitral regurgitation,

Signs of heart failure: basal crackles, elevated JVP, peripheral oedema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What investigations can be used to determine stable angina

A

Bloods test

  • Full blood count,
  • lipid profile and fasting glucose;
  • Electrolytes,
  • liver and thyroid tests

CXR - show other causes of chest pain e.g. pulmonary oedema

Electrocardiogram

Exercise tolerance test/ETT

Myocardial perfusion imaging

Computed tomography (CT) coronary angiography

Cardiac catheterisation/coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What evidence can an electrocardiogram give in investigation fro angina

A

evidence of prior myocardial infarction in pathological Q waves

evidence of left ventricular hypertrophy:
high voltages,
lateral ST-segment depression
“strain pattern”

19
Q

What test is used to confirm the diagnosis of angina and how does it work

A

Exercise tolerance test

Relies on ability to walk for long enough
to produced sufficient CV stress noted on the ECG

20
Q

What is needed for a positive result in ETT

A

Typical symptoms

ECG conformation ST-segment depression

21
Q

What is the disadvantages of ETT

A

Making the patient exert themselves to they suffer with the symptoms
Test less sensitive- doesn’t signify coronary atheroma
Poor specificity - women more like to be hypertensive
If the test is negative doesn’t mean they don’t have angina

22
Q

How is Myocardial perfusion imaging undertaken

A

Radionuclide tracer injected (iv) at peak stress on one occasion, images obtained; and at rest on another

23
Q

What is the advantage of Myocardial perfusion imaging vs ETT

A

Superior to detecting coronary artery disease,

Localisation of ischaemia and assessing size of area affected

allows comparison between stress and rest images

24
Q

What is the disadvantages of Myocardial perfusion imaging

A

Expensive,
involves radioactivity;
depending on availability used where ETT not possible/equivocal.

25
Q

How is stress levels induced

A

Either exercise

pharmacological stress: adenosine, dipyridamole or dobutamine

26
Q

If normal myocardium takes up the tracer what would be seen in comparison to rest and stress in ischaemia and infarction

A

Tracer seen at rest (been taken up) but not after stress = ischaemia
Tracer seen neither rest, or after stress (both abnormal myocardium) = infarction

27
Q

Computed tomography (CT) coronary angiography is an invasive procedure so under what circumstances would the investigation take place

A

Early or strongly positive ETT (suggests multi-vessel ds).

Diagnosis not clear after non-invasive tests.

Young cardiac patients due to work/life effects.

Occupation or lifestyle with risk e.g. drivers etc.

Higher risk factor patients

28
Q

What is the procedure for Cardiac catheterisation/coronary angiography

A

Almost always done under local anaesthetic
Arterial cannula inserted into femoral or radial artery.
Coronary catheters passed to aortic root and introduced into the ostium of coronary arteries.
Radio-opaque contrast (dye) injected down coronary arteries and visualised on X-ray

29
Q

What is the benefits of Cardiac catheterisation/coronary angiography

A

shows distribution and nature of atheromatous disease enabling decision over what treatment options are possible.

Coronary angiography shows stenosis in mid right coronary artery,

See from different angles

30
Q

What is the three different treatment management

A

General measures:
Address risk factors: BP, DM, Cholesterol, Lifestyle

Medical treatment:

  • Reduce progression
  • Relieve symptoms

Revascularisation

  • angioplasty and stenting
  • coronary artery bypass grafting (CABG)
31
Q

What drugs influence disease progression

A

Statins

ACE inhibitors

Aspirin (or clopidogrel if allergic)

32
Q

When are statins used and how doe they work in treating hypertension

A

If total cholesterol >3.5 mmol/l

Reduce LDL-cholesterol deposition in atheroma and also stabilise atheroma reducing plaque rupture and ACS

33
Q

When are ACE inhibitors used and how do they work in the treatment of hypertension

A

If increased CV risk and atheroma

Stabilise endothelium and also reduce plaque rupture

34
Q

How does aspirin 75mg work in the treatment of angina

A

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

35
Q

What medical treatment is used for relief of symptoms

A

B blockers
-reduce myocardial demand and have anti- arrhythmic effect

IK channel blockers

  • SA node inhibitors
  • reduce sinus node rhythm (Ivabridine)

Ca channel blockers

  • achieve resting hr <60 bpm (diltiazem/verapamil)
  • vasodilatation (amlodipine, felodipine)

Nitrates

  • vasodilation preconditioning
  • Used as short or prolonged acting tablets, patches or as rapidly acting sublingual GTN spray for immediate use
K Channel blockers
Preconditioning vasodilatation (nicorandil)
Block the entry of calcium reducing contractions
36
Q

What is the procedure for angioplasty and stenting

aka percutaneous coronary intervention (PCI)

A

Almost always done under local anaesthetic
Arterial cannula inserted into femoral or radial artery.
Coronary catheters passed to aortic root and introduced into the ostium of coronary arteries then cross stenotic lesion with guidewire and squash atheromatous plaque into walls with balloon and stent.

37
Q

What medication should be taken with stent

A

aspirin and clopidogrel

38
Q

Why does endothelium cover the stent struts

A

no longer seen as a foreign body with associated risk of thrombosis

39
Q

What is the benefit of Percutaneous coronary intervention

and what is the disadvantages of the intervention

A

relieves symptoms

No evidence it improves prognosis in stable disease.
Small risk of procedural complication
Risk of restenosis - abnormal narrowing of the arteries

40
Q

What happens in coronary artery bypass grafting (CABG) surgery

A

Long saphenous vein harvested then reversed and used as coronary artery bypass graft therefore bypassing the blocked portion of the coronary artery with a piece of a healthy blood vessel from elsewhere in your body

41
Q

What patents would benefit best from CABG

A
  1. > 70% stenosis of left main stem artery
  2. significant proximal three-vessel coronary artery disease
  3. two vessel coronary artery disease that includes: significant stenosis of proximal left anterior descending coronary artery and who have ejection fraction < 50%.

(basically those who have more severe CAD)

42
Q

What is the advantages and disadvantages to CABG

A

Advantages :
Treats more severe coronary artery disease
Long lasting benefit e.g. 80% symptoms free 5 years later

Disadvantages:
The upfront risks ar higher than PCI
and increase in the presence of co-morbidity

43
Q

What further treatment is needed along side Revascularisation Intervention (CABG and PCI)

A

Patients must continue disease modifying medication

Cardiovascular system SA (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions