Angina

Question 1

What is angina?

Answer 1

Episodic chest pain that occurs during exercise due to decreased coronary artery perfusion

Question 2

What are the causes?

Answer 2

Decreased perfusion- atheroma or embolus
Decreased oxygenation-anaemia
Increased tissue demand- Increased CO

Question 3

What are the risk factors?

Answer 3

Age
Gender
FH
Obesity
DM
Hyperlipidaemia
High fat diet
HTN
Smoking

Question 4

How is it diagnosed?

Answer 4

Clinical diagnoses
Episodic chest pain ranging in severity
Pain that is affected by exercise/emotions/eating
Pain that is relieved by rest and GTN spray
Associated breathlessness

Question 5

What investigations are needed?

Answer 5

Normally clinical diagnoses
BP
ECG
Bloods
-FBC
-HbA1c
-lipids
-TFTs
-LFTs
-U&Es

Coronary artery angiography

• gold standard
• used if diagnoses uncertain

Question 6

What is the conservative management?

Answer 6

Patient education

• importance of healthy diet
• increase exercise

Manage other CV risk factors e.g. HTN

Question 7

What is symptomatic relief?

Answer 7

GTN spray

• helps relieve chest pain
• spray under tongue and wait 5 mins
• pain still present then another spray
• pain present after another 5 mins=ambulance
• can be used prior to exercise

Question 8

What is long term symptomatic relief?

Answer 8

Beta blocker

• contraindicated in asthma
• hypoglycaemia
• bradycardia

CCB- verapamil or diltiazem

• headache
• constipation
• ankle oedema

Can use both together if symptoms not managed with one- cannot combine verapamil with betablocker (prescribe amlodipine)

Question 9

What other medications should be given to patients?

Answer 9

Aspirin
Statin
ACEi