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Flashcards in Stable Angina Deck (20)
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1
Q

Define angina

A

Clinical syndrome characterised by discomfort in chest, jaw, shoulder, back or arm
Aggravated by exertion or emotional stress
Relieved by nitroglycerin
retrosternal
associated with nausea and vomiting
2 hours

2
Q

Who does angina usually occur in?

A

Patients with CAD involving at least 1 major epicardial artery

3
Q

Unstable vs Stable

A
Unstable = occurs during rest, severe new onset, worsens
Stable = for several weeks, predictable, with deterioration
4
Q

Treatment for stable angina

A

PCI or CABG for symptom relief

5
Q

Treatment for unstable

A

Antiplatelet

PCI or CABG = has prognostic benefit

6
Q

What causes angina?

A

Myocardial ischaemia

Due to Lack of oxygen supply or increased demand

7
Q

How may oxygen demand increase?

A

LVH secondary to HTN, AS, HCM

Thyrotoxicosis

8
Q

How may oxygen supply decrease?

A

CAD
Anaemia
Hypoxia

9
Q

Stable Angina Presentation

A
  • central chest pain
  • radiates to arm, neck, jaw teeth
  • heavy, pressure, tight
  • precipitated by exertion/emotion
  • relived by GTN, rest
  • exacerbated by cold weather, hills
  • associated with SOB
  • lasts for minutes
10
Q

Who does stable angina commonly affect?

A
Old man
smokers = stop
HTN 
High cholesterol = statins
Diabetic = measure blood glucose
11
Q

BP Target for patient with stable angina

A

<130/80

12
Q

What to do on exam for stable angina?

A

Measure BP
Listen for murmurs of AS or HCM
Look for xanthelasma

13
Q

What diagnostic tests to do?

A
  • exercise ECG
  • nucelear myocardial perfusion imaging
  • MRI myocardial perfusion imaging
  • stress echo
  • compare each image above to those taken during stress
  • invasive coronary angiogram
  • CT coronary angiography
14
Q

What to do if likelihood of CAD is 61-90%?

A

Offer invasive coronary angiography as first line diagnosis

15
Q

What to do if likelihood of CAD is 30-60%?

A

Offer functional imagine as first line

16
Q

What to do if likelihood of CAD is 10-29%?

A

Offer CT calcium scoring as first line

17
Q

Treatments to improve prognosis

A

Statins
ACEi
Aspirin
Beta Blocker

18
Q

Treatments to improve symptoms?

A

GTN sublingual

Beta Blocker

19
Q

What is beta blocker not tolerated?

A
Anti anginal therapy 2nd line
- calcium channel blocker
long acting nitrate
potassium channel opener (nicorandil)
- ivabradine
20
Q

Coronary Artery Stents

A

Metal lattice Structures
Balloon mounted
Scaffold