Podcast
Questions and Answers
Which of the following is NOT a recommended step in the general management of angina?
Which of the following is NOT a recommended step in the general management of angina?
What is the main action of Glyceryl Trinitrate (GTN) in treating angina?
What is the main action of Glyceryl Trinitrate (GTN) in treating angina?
Which of the following medications is NOT a beta-blocker used in the treatment of angina?
Which of the following medications is NOT a beta-blocker used in the treatment of angina?
What is the recommended daily dosage of aspirin for patients with angina?
What is the recommended daily dosage of aspirin for patients with angina?
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What class of medications do INCLISIRAN and PCSK9 inhibitors belong to?
What class of medications do INCLISIRAN and PCSK9 inhibitors belong to?
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What is the main pathological lesion in Coronary Artery Disease (CAD)?
What is the main pathological lesion in Coronary Artery Disease (CAD)?
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What characterizes Angina Pectoris (chest pain) in terms of its duration?
What characterizes Angina Pectoris (chest pain) in terms of its duration?
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Which of these factors is NOT considered a changeable risk factor for Coronary Artery Disease (CAD)?
Which of these factors is NOT considered a changeable risk factor for Coronary Artery Disease (CAD)?
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What is the underlying mechanism behind the development of Ischemic Heart Disease (IHD)?
What is the underlying mechanism behind the development of Ischemic Heart Disease (IHD)?
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What is the clinical presentation of unstable angina?
What is the clinical presentation of unstable angina?
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Which of the following is considered an angina equivalent?
Which of the following is considered an angina equivalent?
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What is the effect of GTN (nitroglycerin) on chest pain associated with Angina Pectoris?
What is the effect of GTN (nitroglycerin) on chest pain associated with Angina Pectoris?
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Which of the following conditions can contribute to a decrease in coronary blood flow, leading to Angina Pectoris?
Which of the following conditions can contribute to a decrease in coronary blood flow, leading to Angina Pectoris?
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Flashcards
Resting ECG
Resting ECG
An electrocardiogram typically normal between angina attacks, may show ST changes during.
Glyceryl Trinitrate (GTN)
Glyceryl Trinitrate (GTN)
A medication for angina, effective within minutes when taken sublingually.
Beta-blockers
Beta-blockers
Medications that reduce heart rate and workload, used to manage angina symptoms.
Calcium Channel Blockers
Calcium Channel Blockers
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Prophylactic Medications
Prophylactic Medications
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Ischaemic Heart Disease (IHD)
Ischaemic Heart Disease (IHD)
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Coronary Artery Disease (CAD)
Coronary Artery Disease (CAD)
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Angina Pectoris
Angina Pectoris
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Stable Angina
Stable Angina
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Unstable Angina
Unstable Angina
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Risk Factors for CAD
Risk Factors for CAD
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Variant Angina (Prinzmetal's)
Variant Angina (Prinzmetal's)
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Acute Coronary Syndrome
Acute Coronary Syndrome
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Study Notes
Ischaemic Heart Disease (IHD)
- Ischaemic heart disease (IHD) occurs when there's an imbalance between oxygen (and other essential myocardial nutrients) supply and demand.
- Coronary blood flow can be reduced by mechanical obstructions: atheroma, thrombosis, embolus, dissecting aortic aneurysm, coronary ostial stenosis, vasculitis (coronary arteritis), Behçet's, and Kawasaki's disease.
- Angina can result from decreased blood supply (e.g., anaemia, slow coronary flow) or increased demand (e.g., tachycardia, thyrotoxicosis, heavy exertion).
- IHD-non-obstructive coronary disease has a prevalence of approximately 7%, with women having a lower risk of MI than men.
- Coronary artery disease (CAD) is the most common cause and the largest single cause of death in the UK.
- CAD's main pathological lesion is coronary atherosclerosis.
- CAD can present clinically as stable angina pectoris or acute coronary syndrome (unstable angina, myocardial infarction).
Angina Pectoris
- Angina pectoris is characterized by recurrent chest discomfort.
- Pain can radiate to the arms, throat, jaw, or back.
- Pain duration is typically less than 10 minutes.
- Pain is described as tightness and is usually not severe.
- It's aggravated by exertion, cold air, or heavy meals, but relieved by GTN or rest
Types of Angina
- Decubitus angina: pain occurs while lying down.
- Angina equivalent: shortness of breath (SOB) after exertion.
- Nocturnal angina: pain at night.
- Variant (Prinzmetal's) angina: pain at rest.
- Unstable angina: worsening, recent onset, or post-infarction pain, even at rest.
Investigations
- Resting ECGs are often normal between attacks but can show ST depression or T wave inversion during attacks.
- Exercise ECGs can indicate ST segment depression of > 1mm, suggesting a positive test.
- Non-invasive tests include cardiac scintigraphy, exercise ECG tests, echocardiography (including stress echo), CT coronary angiography, and Cardiovascular magnetic resonance (C-MRA).
- Invasive procedures include coronary angiography.
Treatment of Angina
General Management
- Education and lifestyle changes.
- Treating underlying conditions (e.g., anaemia, hypertension, hypo/hyperthyroidism, diabetes).
- Smoking cessation, alcohol cessation
- Treating hypercholesterolaemia.
- Weight loss
- Regular exercise
Medical Treatment
- Symptomatic treatment: Glyceryl trinitrate (GTN) - sublingual or transdermal to rapidly relieve symptoms.
- Beta-blockers (e.g., atenolol, metoprolol, bisoprolol): negative inotropic and chronotropic effects to reduce heart rate and oxygen demand.
- Calcium channel blockers (e.g., nifedipine, amlodipine, verapamil, diltiazem): reduce heart rate and vasodilation.
- Long-acting nitrates (e.g., isosorbide mononitrate).
Prophylactic Medication
- Aspirin: 75 mg/day.
- Lipid-lowering therapy: Statins (e.g., simvastatin, atorvastatin), PCSK9 inhibitors (e.g., inclisiran), fibrates indicated for high LDL-C and elevated trigylcerides (Tg).
Other treatments
- Percutaneous coronary intervention (PCI, PTCA): dilating coronary artery stenosis using a balloon and /or stent.
- Coronary artery bypass grafting (CABG): surgery to create new routes for blood flow around blocked coronary arteries.
- Fibrinolysis: breaking down blood clots using fibrinolytic drugs
Complications of Myocardial Infarction
- Heart failure
- Myocardial rupture/aortic aneurysm
- Ventricular septal defect
- Mitral regurgitation
- Cardiac arrhythmias (e.g., ventricular tachycardia, ventricular fibrillation, atrial fibrillation, conduction disturbances)
- Post-MI pericarditis/tamponade/Dressler's syndrome
Acute Coronary Syndromes
- Unstable angina
- Non-ST-elevation myocardial infarction (NSTEMI)
- ST-elevation myocardial infarction (STEMI)
Pathophysiology (of MI)
- Ischemic heart disease (IHD), leading to prolonged ischemia.
- Cardiac myocyte death.
- Various stages of plaque instability and rupture.
Clinical Presentation of MI (myocardial infarctions)
- New onset chest pain, present at or exacerbated during rest.
- Deterioration of pre-existing angina.
- indigestion,
- chest pain or SOB
- Signs of a systemic reaction (low BP, lung crackles) and murmurs.
Electrocardiogram Findings in MI
- An ECG may or may not show abnormalities.
- ST-segment depression, or T-wave inversion, suggests ischemia.
- Repeated ECG is conducted every 15 minutes to monitor for persistent ST elevation, or new bundle branch block.
- New bundle branch block indicates complete coronary occlusion.
- Transient ST elevation may occur with coronary vasospasm/Prinzmetal's angina.
Biochemical Markers for MI
- Cardiac troponin (I,T and C),
- AST, ALT
- LDH
- Creatine kinase-MB
- Myoglobin
- CRP
- ESR
- WBC
Post Myocardial Infarction (MI) Management
- Medical treatment and lifestyle modifications
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Description
This quiz covers the essentials of Ischaemic Heart Disease (IHD), including its causes, symptoms, and the various types of angina. Understand the impact of factors like coronary artery disease and the risk differences among genders. Test your knowledge on key concepts related to cardiovascular health.
