Angina Flashcards
What is the definition of angina
Crushing central chest pain
On exertion and relieved on rest
Pain radiates to the jaw/neck/shoulder/arm
Reversible with nitrates
Typical = 3/3
Atypical = 2/3
non-angina chest pain = 1/3
(Transient ischaemia, NOT producing myocyte necrosis)
Definition of unstable angina
Pain at rest
>3 episodes of chest pain since first presentation
NYH classification progression <2 months
history of ischaemic heart disease e.g. previous MI
What investigations should be done to determine if there is ischaemic heart disease
Glucose, HbA1c
Lipids
TFTs
ECG (resting + ambulatory)
Resting echo
Structural
Coronary angiogram
Invasive echocardiogram
Functional
Stress echo
NM myocardiac perfusion scanning (stress/dobutamine)
CT PET perfusion
Cardiac MRI stress perfusion
Types of angina
Angina pectoris: 70% vessel occlusion, pain on exertion, no plaque disruption
Unstable angina: >90% occlusion, pain at rest, plaque disruption with superimposed thrombus
Prinzmetal angina: coronary artery spasm (not atheroma)
Management for stable angina
Referral to rapid access chest pain clinic
Anti-anginal
GTN spray
1. beta-blocker
2. CCB (non-DHP e.g. verapamil, diltiazem
3. Long-acting nitrate: isorbide mononitrate, ivabradine, ranolazine, nicorandil
± ACEi
Primary/secondary prevention
- Aspirin 75mg + PPI
- Statin 40mg
Side effects of GTN spray
Headache
Dizziness
Postural hypotension
Advise to lie down when taking
Management for unstable angina
- A-E assessment
- Anti-platelet: Aspirin loading 300mg PO
CALCULATE GRACE SCORE
- If high → Offer PCI immediately (max 72h)
- DAPT: ticagrelor (clopidogrel if high bleed risk)
- Anti-coagulate: Fondaparinuz or LMWH
- Reduce load on heart: beta-blocker (bisoprolol 2.5mg) ± ACEi
- Second line: CCB - Manage risks: statin 80mg
- Manage patient: morphine + anti-emetic
- GTN IV (50mg in 50mL saline at 2-10ml/h)
