Angina

Question 1

Definition of angina

Answer 1

Symptomatic REVERSIBLE myocardial ischaemia

Question 2

3 main symptoms of angina

Answer 2

1. chest pain (radiating to neck/arms)
2. Symptoms on exertion
3. Symptoms relieved by rest or GTN

Question 3

Other symptoms associated with angina

Answer 3

SOB
Nausea
sweaty
feeling faint

Question 4

Factors making angina less likely

Answer 4

continuous pain
pleuritic pain
pain worse on swallowing
pain assoc. with palpitations

Question 5

Causes of angina

Answer 5

Atheroma
Coronary vasospasm
Aortic Stenosis
Tachyarrhythmias
Hypertrophic cardiomyopathy
Arteritis/ Small Vessel Disease

Question 6

Describe Unstable Angina

Answer 6

increased frequency of chest pain
occurs on minimal exertion/rest

crescendo angina

Question 7

What precipitates DECUBITUS angina

Answer 7

lying flat

Question 8

What is PRINZMETAL angina? What do you see on ECG?

Answer 8

Vasospasm
ECG during pain shows ST elevation

Question 9

Describe ECG changes seen in angina

Answer 9

• normal
• ST depression
• TWI may indicate past MI

Question 10

Important blood tests for someone with ?angina

Answer 10

FBC, U&E, LFTs, CRP
Lipids
TFTs
HbA1c
Troponin

Question 11

What investigations can be used to confirm angina?

Answer 11

Exercise Tolerance Test (ETT)
- may show ischaemic changes on ECG when exercising

Angiography to look for atheromatous disease

Question 12

Secondary Prevention

Answer 12

Stop smoking
Diet & exercise
Optimise BP
Optimise diabetic control
Reduced salt diet
Statin if high lipids
75mg aspirin daily

Question 13

What is used for symptomatic relief in angina?

Answer 13

GTN spray

Question 14

Side effects of GTN?

Answer 14

Headaches
Low BP

Question 15

What is the 1st line treatment for angina?

Answer 15

Beta blocker
Calcium channel blocker

Question 16

What beta blocker would you start as first line?

Answer 16

Atenolol 50mg BD
Bisoprolol 5-10mg OD

Question 17

What calcium channel blocker could you consider starting for angina?

Answer 17

Amlodipine 5mg OD
Diltiazem

Question 18

What other drugs could you consider for angina?

Answer 18

Long acting nitrate - Isosorbide mononitrate
Ivabradine 5mg BD
Ranolazine 375mg BD
Nicorandil 5-10mg BD

Question 19

Explain how ivabradine works - What should you ensure before starting it?

Answer 19

Reduces HR with minimal effect on BP
Patient must be in sinus rhythm

Question 20

What management can be used if medical therapy is inadequate?

Answer 20

Revascularisation
- balloon to open stenosed vessel +/- stenting
- CABG