Angina

Question 1

What are the three forms of angina?

Answer 1

Stable
Unstable (type of ACS)
Prizmetal (spasmodic)

Question 2

What is angina?

Answer 2

A mismatch between supply of oxygenated blood to the heart versus myocardial demand.

Question 3

What causes the sensation of chest pain in angina?

Answer 3

Due to narrowing of the coronary vasculature (reduced blood flow)
May also be caused by reduced perfusion pressure (eg low diastolic) or poor collateral blood supply.

Question 4

What does narrowing in angina lead to

Answer 4

Ischaemic type chest pain (often described as pressure/tight but can fluctuate in characteristic)

Question 5

Umbrella for ACS

Answer 5

ECG Change - ST elevation - Stemi

ECG Change - T wave inversion/ ST depression - Raised Troponin - Yes = NSTEMI, No = Unstable Angina

Question 6

What is stable angina caused by?

Answer 6

Narrowing of the coronary artery due to atherosclerosis (hardening of coronary vasculature).
This mismatch of supply vs demand causes pain which occurs during exertion and is relieved by resting or GTN.

Question 7

What is stable angina often the first sign of?

Answer 7

Developing ischaemic heart disease/ coronary artery disease.

Question 8

What are the three ACS?

Answer 8

Stemi
Nstemi
Non stable angina

Question 9

What is unstable angina?

Answer 9

Treated as medical emergency as may be precursor of a MI

Similar symptoms as stable angina, however unstable angina symptoms are present at rest.

Question 10

What is prinzmetal angina?

Answer 10

Cause not well understood but due to coronary spasm.
Potentially due to overreaction from vasoconstrictive stimuli/
Ischaemic cardiac symptom.
Cause may be due to recreational drugs.
Rest doesn’t relieve symptoms.
Treatment is nitrates (GTN) although it isn’t thought to be caused by exertion.