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Cardiovascular system > Stable Angina > Flashcards

Stable Angina Flashcards

1
Q

define stable angina

A

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

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2
Q

what causes this pain?

A

a mismatch between supply of O2 and metabolites to myocardium and myocardial demand for them

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3
Q

name three things that would result in a reduction in coronary blood flow to the myocardium

A

> obstructive coronary atheroma
coronary artery spasm
coronary inflammation/arteritis

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4
Q

what is an uncommon cause of angina that pathologically increases myocardial O2 demand?

A

> left ventricular hypertrophy

> thyrotoxicosis

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5
Q

why do symptoms of angina occur on activity?

A

there is an increase in myocardial oxygen demand but the obstructed coronary blood flow leads to myocardial ischemia and then symptoms of angina

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6
Q

what would an obstructive plaque >70% of the lumen cause?

A

stable angina

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7
Q

what characteristic will pain have?

A 
Site = retrosternal
Character = tight band
Radiation = neck, jaw, down the arms
Aggravating = exertion, emotion
Relieving Factors = rapid improvement with GTN or physical rest
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8
Q

name some features that make angina less likely

A 
> sharp/stabbing pleuritic pain
> associated with body movement
> localised
> superficial
> no pattern to onset
> beginning some time after exercise
> lasting for hours
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9
Q

what is the differential diagnosis for chest pain?

A

> cardiovascular disease
respiratory
musculoskeletal
GI causes

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10
Q

stable angina can sometimes present with no chest pain but other symptoms on exertion such as…….?

A

> breathlessness
excessive fatigue
near syncope

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11
Q

in what people may pain not be a symptom?

A

the elderly or those with diabetes mellitus

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12
Q

what is number one on the CCS scale?

A

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

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13
Q

what is number 2 on the CCS scale?

A

there is slight limitation of ordinary activity, symptoms are on walking more than 1 flight of stairs

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14
Q

what is number three on the CCS?

A

there is marked limitation and symptoms are on walking up 1 flight of stairs

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15
Q

what is number three on the ccs?

A

symptoms on any activity, getting washed/dressed

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16
Q

name some non-modifiable risk factors for coronary heart disease

A

> age
gender
race
family history/genetics

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17
Q

name some modifiable risk factors for coronary heart disease

A 
> smoking
> lifestyle
> diabetes mellitus
> hypertension
> hyperlipidaemia
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18
Q

what should you look for on general examination with stable angina?

A

> tar stains
obesity
xanthalasma and corneal arcus (hypercholseterolaemia)
hypertension
abdominal aortic aneurysm arterial bruits: absent/reduced peripheral pulses
diabetic retinopathy

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19
Q

name some signs of associated conditions

A

> pallor: anaemia
tachycardia, tremor, hyper-reflexia: hyperthyroidism
ejection diastolic murmur: aortic stenosis
pansystolic murmur: mitral regurgitation#
basal crackles, elevated JVP, peripheral oedema: heart failure

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20
Q

what investigations should be carried out?

A 
> bloods
> chest x-ray
> electrocardiogram
> exercise tolerance test
> myocardial perfusion imaging
> computer tomography coronary angiography
> invasive angiography
> cardiac catherterisation
21
Q

what blood tests are carried out in investigation of angina?

A 
> full blood count
> lipid profile
> fasting glucose
> electrolytes
> liver and thyroid
22
Q

what may an electrocardiogram give evidence of?

A

> prior myocardial infarction

> left ventricular hypertrophy

23
Q

what would indicate a positive result in an exercise tolerance test?

A

typical symptoms and a st-segment depression

24
Q

describe how a myocardial perfusion imaging test is carried out

A

radionuclide tracer injected at peak stress and then again at rest. the two images are compared. the normal myocardium takes up the tracer

25
Q

what is indicated if the tracer in a myocardial perfusion imaging test is taken up at rest up not under stress?

A

ischemia

26
Q

what is indicated if the tracer is not taken up at rest or during stress in a myocardial perfusion imaging test?

A

infarction

27
Q

when should an invasive angiography be carried out?

A

> early/strong positive ETT
diagnosis is not clear
young cardiac patients due to work/lifestyle
occupation/lifestyle risk

28
Q

what will a coronary angiography give you?

A

definition of coronary anatomy with sites, distribution and nature of the atheromatous disease

29
Q

describe how a cardiac catheterisation/coronary angiography is carried out

A

> local anaesthetic
arterial cannula is inserted into femoral/radial artery
coronary catheters passed to aortic root and introduced into the ostium of coronary arteries
the radio-opaque contrast is injected down coronary arteries and visualised on an x-ray

30
Q

what can be carried out if the symptoms of stable angina are not controlled?

A

revascularisation: percutaneous coronary intervention and coronary bypass grafting

31
Q

what medication can be given to influence the disease progression?

A

> statins
ACE inhibitors
aspirin

32
Q

what are the effects of statins?

A

they reduce LDL-cholesterol deposition in atheroma and stabilise the atheroma reducing plaque rupture and ACS

33
Q

when should you use ACE inhibitors?

A

if there is an increased CV risk and atheroma

34
Q

what is the effect of ACE inhibitors?

A

it stabilises the endothelium and reduces plaque rupture

35
Q

what is the action of aspirin?

A

it doesn’t directly effect the plaque but protects the endothelium and reduces platelet activation

36
Q

what medical treatment is given to relieve symptoms?

A 
> beta-blockers
> calcium channel blockers
> Ik channel blockers
> nitrates
> potassium channel blockers
37
Q

what is the action of beta blockers?

A

it reduces myocardial work and have anti-arrhythmic effects

38
Q

what is the action of Ik channel blockers?

A

it reduces sinus node rate

39
Q

what do calcium channel blockers create?

A

vasodilatation

40
Q

what do nitrates produce?

A

vasodilatation

41
Q

how are nitrates administered?

A

with short of long acting tablets/ patches or rapidly acting sublingual GTN spray

42
Q

name a potassium channel blocker used for stable angina?

A

nicrorandil

43
Q

what is percutaneous coronary intervention?

A

precutanrous transluminal coronary angioplasty and stenting

44
Q

describe the process of stenting

A

the stenotic lesions are crossed with guided wire squashing the atheromatous plaque in the walls with the balloon and stent

45
Q

what should be taken after a stent is put into place and why?

A

aspirin and clopidogrel taken together until the endothelium covers the stent struts and it is no linger seen as a foreign body

46
Q

what patient groups have good prognostic benefits with coronary bypass surgery?

A

> more than 70% stenosis of left main artery
significant proximal three-vessel coronary artery disease
two vessel coronary artery disease that includes significant stenosis of proximal left anterior descending coronary artery

47
Q

why does a coronary bypass surgery deteriorate after 10 years?

A

a vein is used to bypass the coronary circulation but veins are not built to bypass the arterial system

48
Q

what is coronary artery bypass surgery?

A

the internal mammary artery is moved to the coronary artery. this will usually last a lifetime.

Cardiovascular system (34 decks)

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