Stable Ischaemic Heart Disease and Angina Presentation and Investigation Flashcards Preview

R-Cradio-illness > Stable Ischaemic Heart Disease and Angina Presentation and Investigation > Flashcards

Flashcards in Stable Ischaemic Heart Disease and Angina Presentation and Investigation Deck (59)
Loading flashcards...
1

What is angina?

Discomfort/pain in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis

2

What is angina a result of?

Mismatch between supply of oxygen and metabolites to the myocardium and the myocardial demand for them

3

What is angina most commonly due to?

Reduction in coronary blood flow to the myocardium caused by;
obstructive coronary atheroma
coronary artery spasm
coronary inflammation/arteritis

4

What might cause angina, other than reduction in coronary blood flow to the myocardium?

Reduced oxygen transport e.g. anaemia of any cause
Pathologically increased myocardial oxygen demand e.g. left ventricular hypertrophy or thyrotoxicosis

5

What is the most common cause of angina?

Coronary atheroma

6

When does myocardial oxygen demand increase?

In situations where heart rate and blood pressure rise e.g. exercise, anxiety, emotional stress etc.

7

What is necessary in order for ischaemia to occur?

Lumen has to be reduced by more than 70%

8

What are the non-modifiable risk factors of stable angina?

Age
Gender
Creed
Family history
Genetics

9

What are the modifiable risk factors of stable angina?

Smoking
Lifestyle e.g. diet and exercise
Diabetes mellitus
Hypertension
Hyperlipidaemia

Good control of diabetes, hypertension and hyperlipidaemia reduce the risk

10

What are the typical characteristics of angina?

Retrosternal site
Described as tight band/pressure/heaviness
May radiate to neck, jaw or down arms
Aggravated by exertion and emotional stress
Relieved by GTN and physical rest

11

Give some characteristics of pain that make the diagnosis of angina less likely

Sharp/stabbing pain
Associated with normal body movements or respiration
Very localised
Superficial
No pattern to pain
Begins some time after exercise
Lasts for hours

12

What are some cardiovascular differential diagnoses of chest pain?

Angina
Aortic dissection
Pericarditis

13

What are some respiratory differential diagnoses of chest pain?

Pneumonia
Pleurisy
Peripheral pulmonary emboli

14

What are some musculoskeletal differential diagnoses of chest pain?

Cervical disease
Costochondritis
Muscle spasm or strain

15

What are some gastrointestinal differential diagnoses of chest pain?

Gastro-oesophageal reflux
Oesophageal spasm
Peptic ulceration
Biliary colic
Cholecystitis
Pancreatitis

16

If myocardial ischaemia occurs without chest pain, what other symptoms might be present on exercise? Who is this more common in?

Breathlessness
Excessive fatigue for the activity undertaken
Near syncope on exertion

More common in the elderly or those with diabetes mellitus

17

What is the Canadian Classification of Angina Severity (CCS) grading?

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

II – slight limitation of ordinary activity, symptoms on walking 2 blocks or > 1 flight of stairs

III – marked limitation, symptoms on walking only 1-2 blocks or 1 flight of stairs

IV – symptoms on any activity, getting washed/dressed causes symptoms

18

What signs might be seen on examination of a patient with angina?

Tar staining
Obesity (centripetal)
Xanthalasma
Hypertension
Abdominal aortic aneurysm bruits
Absent or reduced peripheral pulses
Diabetic retinopathy or hypertensive retinopathy

19

What signs of exacerbating/associated conditions might be seen on examination of a patient with angina?

Pallor of anaemia
Tachycardia, tremor, hyper-reflexia or hyperthyroidism
Ejection systolic murmur, plateau pulse of aortic stenosis
Pansystolic murmur of mitral regurgitation
Signs of heart failure e.g. basal crackles, elevated JVP, peripheral oedema

20

What blood tests are relevant in the investigation of stable angina?

FBC
Lipid profile
Fasting glucose
Electrolytes
Liver function tests
Thyroid function tests

21

What investigations (other than blood tests) are relevant in the investigation of stable angina?

CXR
Electrocardiogram
Exercise tolerance test
Myocardial perfusion imaging
Cardiac catheterisation/coronary angiography

22

In what percentage of cases of angina will the electrocardiogram be normal?

Over 50%

23

What might an electrocardiogram show evidence of?

Previous MI e.g. pathological Q waves
Left ventricular hypertrophy e.g. high voltages, lateral ST-segment depression

24

How is an exercise tolerance test useful?

Can often confirm the diagnosis of angina

25

When is an exercise tolerance test positive?

When patient has typical symptoms and ST-segment depression

26

What does an exercise tolerance test depend on?

Ability to walk for long enough to produce sufficient cardiovascular stress

27

What is the prognosis of a negative exercise tolerance test?

Doesn't exclude significant coronary atheroma but if negative at a high workload the overall prognosis is good

28

In what ways is myocardial perfusion imaging superior to exercise tolerance testing?

Detection of coronary artery disease
Localisation of ischaemia
Assessing size of area affected

29

What are the disadvantages of myocardial perfusion imaging?

Expensive
Involves radioactivity

30

When should myocardial perfusion imaging be used?

Where ETT is not possible or is equivocal