Angina

Question 1

What is angina

Answer 1

Common presentation of ischaemic heart disease with fixed stenosis of heart itself

Question 2

What are the 2 types of angina

Answer 2

Stable - attacks have triggers stop after a few minutes of rest
Unstable - unpredictable attacks which do not always stop with rest = serious

Question 3

What is the aetiology of angina

Answer 3

atherosclerosis in vessels
- leads to lack of blood supply to heart

Question 4

Pathophysiology of angina

Answer 4

Narrowing of coronary arteries leads to less blood flow to myocardium
During time in demand e.g. exercise, there is insufficient blood supply causing symptoms

Question 5

Symptoms and Signs of angina

Answer 5

Chest discomfort centrally/left-sided
Described as crushing/tightness
Pain can radiate to jaw
+/- SOB
Usually result of exertion relived by rest

Question 6

Investigations

Answer 6

Angina diagnosed clinically

Other tests look for coronary disease as the cause e.g.
ECG
CT coronary angiograph
exercise tolerance test
Myocardial perfusion scan
Catheter angiography

Question 7

Lifestyle management of angina

Answer 7

Smoking cessation
Limit alcohol intake
Diet & exercise advise
BMI should be 25 or less

Question 8

Pharmacological management of angina

Answer 8

Symptomatic relief= GTN spray

Long term relief (2nd line)=
Long acting nitrate (isosorbide mononitrate)
Nicorandil = K+ channel activator
Ivabradine
Ranolazine

Question 9

What are the secondary prevention drugs used in angina

Answer 9

1. ACE inhibitor
2. Aspirin
3. Atorvastatin

Question 10

Surgical Intervention of angina

Answer 10

coronary artery bypass graft (CABG) for very severe stenosis

Percutaneous Coronary Intervention (PCI) with coronary angioplasty is offered to patients with ‘proximal or extensive disease’on CTCA