126 - Chronic, stable angina

Question 1

What is Angina?

Answer 1

Retrosternal chest pain/pressure

Occurs during exertion

Question 2

Describe ECG during angina attack

Answer 2

ST depression

Question 3

What relieves angina?

Answer 3

Rest/GTN spray

Question 4

Short term control of angina symptoms

Answer 4

Prescribe sublingual GTN spray - show patient how to use.

Question 5

Long term prevention of angina symptoms

Answer 5

Treat with Beta blocker unless contraindicated.

Patient must not stop suddenly/allow to run out of drug.

Question 6

Purpose of aspirin for angina patients?

Answer 6

Clot prevention

Question 7

Purpose of simvastatin for angina patients

Answer 7

Lower cholesterol

Question 8

Purpose of GTN for angina patients

Answer 8

Vasodilator

Question 9

Purpose of B-blocker for angina patients

Answer 9

Vasodilator

Question 10

Purpose of CCB for angina patients

Answer 10

Vasodilator

Question 11

When is angina stable?

Answer 11

Symptoms occur only after exertion and subside in minutes

Question 12

When is angina unstable

Answer 12

Symptoms occur unpredictably Treat as an emergency.

Question 13

Describe the levels of the Canadian Cardiovascular Society Angina Grading System

Answer 13

Grade 1 - only during strenuous activity.
Grade 2 - Slight limitation. Climbing stairs.
Grade 3 - Marked limitation - walking on level.
Grade 4 - Angina at rest or all activity causes angina.

Question 14

Risk factors for angina

Answer 14

Smoking
Diet
Hypertension
Also - FH, hyperlipidemia, DM, Obesity, sedentary lifestyle, age, M>F (before menopause)

Question 15

Myocardial ischaemia caused by:

Answer 15

Insufficent supply or high demand.

Question 16

What is Decubitus angina

Answer 16

Occurs when lying flat. Generally related to heart failure.

Question 17

What is Prinzmental’s angina

Answer 17

Caused by coronary artery spasm

Question 18

Signs/symptoms of angina

Answer 18

Pain - reterosternal, crushing, radiating, stops within minutes of exertion stopping
Dyspnoea
Added heart sounds during ischemia

Question 19

Differential dx for angina

Answer 19

Reflux, PE, aortic dissection, shingles.

Question 20

Investigations for Angina

Answer 20

Bloods - FBC, U&Es, Glucose, Lipids, TFTs, LFTs, Troponin (if ECG changes)
ECG - expect ST depression
Echo if hypertrophic cardiomyopathy/aortic valve suspected

Question 21

Assessment of coronary artery disease

Answer 21

Based on clinical assessment.
Risk factors/age
Estimate risk to determine need for further investigations.

Question 22

2 types of treatment for Angina

Answer 22

Risk modification - lifestyle

Pharmacological