Angina Flashcards

1
Q

what is it

A

restricted perfusion of heart due to atherosclerosis

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2
Q

what is difference between stable and unstable angina

A

stable is on exertion

unstable (ACS) is angina of recent onset or worse at rest

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3
Q

what is the symptoms

A

tight, heavy, dull chest pain that passes within few minutes
radiate to left arm, neck, jaw or back
normally following exertion, stress, after meal or cold weather

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4
Q

what causes it

A

atherosclerosis due to hypertension, hyperlipidaemia, smoking, diabetes, age, sex

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5
Q

how is it diagnosed

A
symptoms
ECG
exercise tolerance test 
coronary angiography (assess coronary circulation)
myocardial perfusion scinigraphy
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6
Q

what is ECG findings

A

between attacks - may be normal, or pathological Q waves (old MI), LVH/LBBB

during attacks - transient ST depression, t wave inversion

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7
Q

what is the treatment

A

GTN + secondary prevention (aspirin, ACEi and statin)

B blocker or CCB (verapamil) (if symptoms persist then B blocker + amlodipine)

If B blocker and/or CCB contradicted, give long acting nitrate or HCN channel activator or K+ activator

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8
Q

what is the mechanism of GTN (nitrate)

A

releases nitrate which are converted to nitric oxide which activates guanylyl cyclase, increasing cGMP. this cGMP activates PKG which relaxes vascular smooth muscle

The reduced [Ca2+], since more is taken up by SER, decreases MLCK activity and relaxation occurs due to reduced light chain phosphorylation

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9
Q

side effects of GTN

A

headaches, hypotension, syncope, tolerance

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10
Q

what is mechanism of aspirin (anti-platelet)

A

reduces platelet aggregation and arterial thrombosis by activating plasminogen to plasmin, dissolving thrombi

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11
Q

what are side effects of aspirin

A

bronchospasm, GI irritation, GI haemorrhage

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12
Q

what is mechanism of ACEI (lisinopril, ramipril, enalapril)

A

decrease synthesis of angiotensin II, a powerful vasoconstrictor, reducing vascular done (causing vasodilation)

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13
Q

what is the side effects of ACEI

A

dry cough, angiodema, proteinuria, neutropenia, renal failure, hyperkalaemia

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14
Q

what is mechanism of statins (atorvastatin, simvastatin, pravastatin)

A

HMG CoA reductase inhibitors - block cholesterol synthesis in liver. Compensatory mechanism incomplete and reduction of cholesterol in hepatocytes leads to increased LDL receptor expression, increasing clearance from plasma

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15
Q

what is side effects of statins

A

myopathy

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16
Q

what is mechanism of B blocker (bisoprolol)

A

block B-adrenoceptors

lower CO and decrease force of cardiac contraction

17
Q

what are side effects of B blocker

A

cold hands, fatigue, provocation of asthma, heart failure, conductance block, nightmares

18
Q

what is mechanism of calcium channel blockers (amlodipine, nifedipine, verapamil)

A

block L type calcium channels, preventing calcium from entering cells, causing relaxation of arteriolar smooth muscle (reduced TPR so BP falls)

19
Q

what is side effects of CCB

A

dizziness, hypotension, flushing, ankle oedema

20
Q

what is mechanism of long acting nitrate (isosorbide mononitrate)

A

same as GTN

21
Q

what is mechanism of HCN channel inhibitor (ivabradine)

A

reduces HR via specific inhibition of funny current

22
Q

what is mechanism of K+ activator (nicrorandil)

A

potassium channel activator with nitrate component which has arterial and venous vasodilating properties

23
Q

what surgeries can be considered in angina

A

PCI and CABG

24
Q

what is PCI

A

dilation of coronary artery using ballon and stent inserted via femoral/radial/brachial artery
patient must be anticoagulated and antiplateleted beforehand

25
Q

what is CABG

A

left internal thoracic (mammary) cut distally and attached to coronary artery
or saphenous vein used - one end attached to ascending aorta and other to obstructed vessel

26
Q

what are complications of CABG

A

systemic inflammatory response, AF and persistent neurological abnormalities

27
Q

what is complications of angina

A

heart attack
stroke
depression

28
Q

how to tell difference between unstable angina and NSTEMI

A

unstable angina does not have detectible markers