4. Angina

Question 1

What is angina?

Answer 1

Reversible myocardial ischaemia

Question 2

What are the three main features of angina?

Answer 2

1. Constricting/heavy discomfort to the chest, jaw, neck shoulder or arms
2. symptoms brought on by exertion
3. Symptoms relieved by 5 minute rest or GTN

Question 3

What is the difference between angina and unstable angina

Answer 3

Angina- exertion

Unstable angina- May come on at rest

Question 4

What precipitates angina?

Answer 4

Cold
Emotion
Heavy meals

Question 5

What are the physiological/pathological causes of angina?

Answer 5

Atheroma
Coronary artery spasm
Tacharrythmias
Arteritis/small vessel disease

Question 6

What tests/investigations can be done for angina?

Answer 6

ECG
ECHO 
Chest x Ray
FBC, HBA1c, TFT’s, U&E’s
Angiography 
Exercise ECG

Question 7

What non pharmacological actions can be taken to combat angina?

Answer 7

Address exacerbating factors: anaemia, tachycardia, thyrotoxicosis

Lifestyle: exercise, dietary advice, optimise hypertension and diabetes

Revascularisation

Question 8

What medications are used to treat angina?

Answer 8

GTN!

75mg aspirin daily

Beta blockers and/or calcium channel blockers first line

Also consider simvastatin, ivabradine, ace inhibitors (diabetic),

Question 9

What is involved with revascularisation?

Answer 9

Percutaneous coronary intervention- balloon and stent

CABG- open heart surgery bypass graft

Question 10

What is done after percutanous coronary intervention?

Answer 10

Dual anti-platelet therapy (aspirin and clopidogrel)

To prevent in stent thrombosis