Stable Ischaemic Heart Disease (SIHD) and Angina Flashcards Preview

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Flashcards in Stable Ischaemic Heart Disease (SIHD) and Angina Deck (26)
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1

What is the DEFINITION of ANGINA?

1) Discomfort/Pain Chest and/or Adjacent Areas
2) Associated with Myocardial Ischaemia

*No Myocardial Necrosis

2

Describe the PATHOPHYSIOLOGY of STABLE ANGINA (SA):

Mismatch Between Supply of O2 and Metabolites to the Myocardium and the Myocardial Demand for Them

3

What are the UNCOMMON CAUSES of SA?

1) Coronary Artery Spasm
2) < O2 Transport, i.e. Anaemia
3) > Myocardial O2 Demand, i.e. Left Ventricular Hypertrophy (LVH)

4

What is the MOST COMMON CAUSE of SA?

< Coronary Blood Flow due to Obstructive Atheroma

5

When are SA SYMPTOMS MANIFESTED?

Only on Exertion

6

What are some of the PRECIPITANTS for SA CHEST PAIN?

1) Exercise
2) Cold Weather
3) Emotional Stress
4) After a Large Meal

7

What DIAGNOSTIC TOOL can be used to ASSESS the SEVERITY of Angina?

Canadian Classification of Angina Severity (CCS)

8

What are the NON-MODIFIABLE RISK FACTORS for Coronary Artery Disease?

1) Age
2) Gender
3) Race
4) Family History
5) Genetic Factors

9

What are the MODIFIABLE RISK FACTORS for Coronary Artery Disease?

1) Smoking
2) Lifestyle - Exercise and Diet
3) Diabetes Mellitus (Better Glycaemic Control)
4) Hypertension (BP Control)
5)Hyperlipidaemia (< Cholesterol)

10

What are the SYMPTOMS of SA?

Exertional Chest Pain/Discomfort

Can also present with the following, in the Absence of Chest Pain

- Exertional Dyspnoea
- Excessive Exertional Fatigue
- Exertional Presyncope

11

Describe some of the CHARACTERISTICS of SA CHEST PAIN:

Site - Retrosternal

Onset - Sudden

Character - Tight Band/ Pressure

Radiation - Neck and/or Jaw; Down the Arms

12

What are some of the SIGNS of SA?

1) Tar Staining of Fingers
2) Obesity
3) Xanthalasma
4) Corneal Arcus
5) Hypertension
6) Absent/< Peripheral Pulses
7) Abdominal Aortic Aneurysm
8) Arterial Bruits

13

What INVESTIGATIONS would be used to diagnose SA?

1) FBCs - Serum Biochemistry (Lipid Profile and Fasting Glucose; U and Es, LFTs and Thyroid)
2) CXR
3) ECG
4) Exercise Tolerance
5) Myocardial Perfusion Scanning
6) CT-Coronary Angiography
7) Invasive Angiography
8) Cardiac Catheterisation/Coronary Angiography

14

What would be EXPECTED on ECG from a patient, with SA, subjected to EXERCISE?

ST-Segment Depression

15

What PHARMACOLOGICAL TREATMENT would ALLIEVIATE the SYMPTOMS of SA RAPIDLY?

Glyceryl Trinitrate (GTN)

16

What MANAGEMENT STRATEGIES can be employed to TREAT SIHD and Angina?

1) General Measures
- Address Risk Factors: BP; DM; Cholesterol and Lifestyle
2) Medical Treatment
- Drugs to < Disease Advancement and Symptoms
3) Revascularisation, i.e. PCI and CABG

17

What MEDICAL TREATMENTS can be used to attenuate SIHD and SA DISEASE PROGRESSION?

1) Statins, i.e. Simvastatin
2) ACEIs
3) Aspirin (Clopidogrel, if Intolerant of Aspirin)

18

What MEDICAL TREATMENTS can be used for RELIEF of SIHD SYMPTOMS?

1) Beta-Blockers, i.e. Bisoprolol and Atenolol
2) CCBs, i.e. Amlodipine
3) "Funny" Channel Blockers, i.e. Ivabradine
4) Nitrates, i.e. GTN Spray
5) K+ Channel Agonist, i.e. Nicorandil

19

If symptoms of SIHD or SA are NOT RELIEVED/RESOLVED by general and medical measures, what are the NEXT STEPS in MANGEMENT?

Revascularisation

1) Percutaneous Coronary Intervention (PCI) and Stenting
2) Coronary Artery Bypass Grafting (CABG)

20

What are the MAIN PHYSIOLOGICAL MECHANISMS that are ATTENUATED by pharmacological therapy in SIHD and Angina?

Cardiac Workload:

1) Heart Rate
2) Myocardial Contractility
3) Afterload

21

What does the 'REBOUND PHENOMENON' in BETA-BLOCKER use constitute?

Sudden Cessation of Beta-Blockers may Precipitate an MI

*< Dose of Beta-Blockers Over a Week or Two

22

What are the MAIN CONTRAINDICATIONS to Beta-Blocker use for SIHD and Angina?

1) Asthma
2) Heart Failure
3) Bradycardia/Heart Block
4) Raynaud's Syndrome
5) PVD

23

What are the DANGERS of using NIFIDEPINE IMMEDIATE RELEASE as a treatment for CVS disease?

Rapidly Acting Vasodilatatory-CCB that May Precipitate Acute MI or Stroke

Contraindications
- Post MI
- Unstable Angina

24

What TREATMENTS are the "MAIN-STAYS" in UNSTABLE ANGINA?

IV Nitrates + LMWH

25

What are the ADVERSE DRUG REACTIONS caused by NITRATES?

1) Headache
2) Hypotension
- GTN Syncope (Sig. in the Elderly; > Falls Risk)

26

Why should LOW DOSE ASPIRIN be used in slow the progression of Chronic SA, particularly in the ELDERLY?

Common Cause of GI Bleed