Stable Angina Flashcards
(32 cards)
Angina
A discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis
Stable angina pathophysiology
Mismatch between supply of oxygen and metabolites to myocardium and the myocardial demand for them
Stable angina can be caused by
Reduction in coronary blood flow to myocardium
Reduced oxygen transport
Increased myocardial oxygen demand
Most common cause of angina
Coronary atheroma
Myocardial oxygen demand increases in situation where
Heart rate and blood pressure rise
Stable angina can be precipitated by
Exertion
Cold weather
Emotional stress
Following a heavy meal
History of pain in angina
Retrosternal
Tight band/pressure/heaviness
Radiation to neck and/or into jaw, down arms
Aggravating with exertion, emotional stress
Relieving factors of rapid movement with GTN or physical rest
Differential diagnosis for chest pain
Other cardiovascular cause
Respiratory
Musculoskeletal
GI causes
Symptoms of angina on exertion
Dyspnoea
Excessive fatigue
Near syncope
Chest pain
Type I angina
Symptoms only on significant exertion, ordinary physical activity does not cause angina
Type II angina
Slight limitation of ordinary activity, symptoms on walking 2 blocks or >1 flight of stairs
Type III angina
Marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs
Type IV
Symptoms on any activity, getting washed/dressed causes symptoms
Non-modifable risk factors for stable angina
Age Gender Creed Family history Genetic factors
Modifiable risk factors of stable angina
Smoking Lifestyle Diabetes mellitus Hypertension Hyperlipidaemia
Diseases that can cause stable angina
Obstructive coronary atheroma Coronary artery spasm Coronary inflammation/arteritis Anaemia Left ventricular hypertrophy Aortic stenosis Hypertrophic cardiomyopathy Thyrotoxicosis
Examination findings of stable angina
Tar stains on fingers Obesity Xanthalasma and corneal arcus Hypertension Abdominal aortic aneurysm Arterial bruits (murmurs) Absent or reduced peripheral pulses Diabetic retinopathy, hypertensive retinopathy on fundoscopy
Examination findings of exacerbating or associated conditions of stable angina
Pallor of anaemia
Tachycardia, tremor, hyper-reflexia or hyperthyroidism
Ejecting systolic murmur, plateau pulse of aortic stenosis
Pansystolic murmur of mitral regurgitation
Sign of heart failure - basal crackles, elevated JVP, peripheral oedema
Investigation of stable angina
Bloods - FBC, lipid profile, fasting glucose, electrolytes, liver, thyroid
Chest x-ray
ECG
Exercise tolerance test - ST segment depression with ECG
Myocardial perfusion imaging - comparison between stress and rest images
CT coronary angiography
Invasive angiography
Tracer seen at rest but not after stress means
Ischaemia
Tracer seen neither rest or after stress means
Infarction
Investigations of chronic stable angina
Cardiac catheterisation/coronary angiography
General measures of stable angina
Address risk factors: Blood pressure Diabetes mellitus Cholesterol Lifestyle
Revascularisation of stable angina is carried out if
Symptoms not controlled
