Angina |
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| 2007-12-22 |  History  |  | Add My version | |
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Angina
Characteristics
Definition
Chest pain
exertion
minutes in duration
Types
Classic angina
exertion
pain
minutes
rest
relief
Variant (Prinzmetal's)
@ rest
vasospastic
Unstable angina
aka acute coronary syndrome or NSTEMI
between MI & angina
@ rest
atherosclerotic plaque
fissured
platelet rich clot
management
heparin
aspirin
antianginal drugs
abciximab
high risk
Decubitus angina
lying down
Cardiac syndrome X
+ve exercise test
normal angiogram
microcirculation problem?
S&S
CP
retrosternal
crushing
radiates
arms
neck
Aggravating
activity
cold
anger
emotion
Differential
Chest wall pain
GORD
Complications
MI
Death
Management
Investigations
Imaging
radionuleotide
thalium 201
technetium 99-labelled sestamibi
Angiography
Exercise ECG
T wave
ok
between attacks
25%
CAD
exclude pathology
inversion
flattening
depression
>1mm
severe CAD
BP
exercise
paradoxical
severe CAD
Treatment
Aggravating factors
thyrotoxicosis
hypercholesterolaemia
anaemia
valve disease
Behavioural
smoking
weight
Aspirin
75mg/day
Lipid lowering agents
cholesterol >4.8mmol/L
statins
Beta blockers
atenolol
metoprolol
CI asthma, PVD
Ca antagonists
diltiazem
amlodipine
nifedipine
GTN
in attacks
prophylactic
b4 exercise
SE
headache
hypotension
nitrates
slow release
isosorbide mononitrate
isosorbide dinitrate
Nicorandil
K channel activator
GTN like also
Surgical
Angioplasty
indications
non-calcified
single
proximal
post-angio
antiplatelets
aspirin
clopidigrel
abciximab
platelet glycoprotein IIb/IIIa receptor inhibitors
CABG
Prognosis
stable
4% mortality/year
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