Angina

Question 1

what is another name for angina?

Answer 1

stable coronary artery disease

Question 2

define stable coronary artery disease

Answer 2

a chronic / recurrent and acute ischaemic heart disease syndrome

Question 3

what is a angina (pectoris) commonly associated with?

Answer 3

transient chest discomfort or strangling and choking pain in the chest

Question 4

what characterises stable coronary artery disease?

Answer 4

• reversible or transient episodes of mismatch between myocardial oxygen supply/demand
• related to myocardial ischaemia or hypoxia without cell necrosis (tissues can recover)

Question 5

what is classic angina?

Answer 5

atherosclerotic plaque-related partial obstruction of epicardial coronary arteries

Question 6

what is variant angina?

Answer 6

transient, focal or diffuse, spasm of normal or mildly-diseased epicardial coronary arteries

Question 7

what is microvascular angina?

Answer 7

a primary dysfunction of small diameter (<500 µm) intramural coronary arteries

Question 8

what are the two major subtypes of angina?

Answer 8

• Angina with obstructive CAD (stable/classic angina)
• Angina without obstructive CAD (INOCA/NOCAD)

Question 9

three features of angina with obstructive CAD

Answer 9

chest pain on exertion
fixed obstructive CAD (atherosclerotic plaque)
ST-segment depression

Question 10

4 features of variant angina?

Also called Variant/Prinzmetal/Angiospastic/Vasospastic or Microvascular

Answer 10

pain at rest or at night
focal or diffuse spontaneous coronary artery spasm
ST-segment elevation
arrhythmias

Question 11

4 features of microvascular angina?

Answer 11

-chest pain at rest or exertion (pain persists after resting and poor response to GTN)
-no angiographic evidence of obstructive CAD
-coronary microvascular dysfunction (endothelial dysfunction, abnormal dilator response, coronary microvascular spasm, heightened response to vasoconstrictors and reduced coronary flow reserve)
-positive stress test – ST-segment depression during
exercise

Question 12

What clinicla features should you look for in angina?

Answer 12

1) Location
2) Radiation
3) Character
4) Duration
5) Triggers

Question 13

what is usually the duration of angina?

Answer 13

brief, less than 10 minutes

Question 14

what is the location of anginal pain

Answer 14

retrosternal, near the sternum

Question 15

what can trigger angina?

Answer 15

physical exertion, emotional stress, heavy meals and exposure to cold

Question 16

where does pain radiate in angina?

Answer 16

throat, lower jaw, upper arms, back, epigastrium

Question 17

what is the character of anginal pain

Answer 17

pressure, heaviness, tightness, discomfort, strangling, constricting, burning (fist)

Question 18

what are the 3 signs and symptoms ( clinical features) of angina?

Answer 18

1) Pain
2) Haemodynamic-breathlessness, dizziness, syncope, due to ischaemia-induced transient LV dysfunction
2) ECG- Depression/ elevation in ST segment

Question 19

ST depression vs Elevation

Answer 19

Depression - Subendocardial Ischaemia
Elevation - Transmural Ischaemia

Question 20

NICE diagnostic work up for angina

Answer 20

Question 21

what is class 1 angina?

Answer 21

• ordinary activity does not cause angina
• angina with strenuous, rapid, or prolonged exertion only

Question 22

what is class 2 angina?

Answer 22

-slight limitation of ordinary activity,
-angina on walking or climbing stairs rapidly, walking uphill or exertion after meals, or only during the first few hours after waking

Question 23

class 3 angina?

Answer 23

• marked limitation on ordinary physical activity
• Angina on walking one or two blocks on the level or one flight of stairs at a normal pace under normal conditions

Question 24

class 4 angina?

Answer 24

‘Inability to carry out any physical activity without

discomfort’, or ‘angina at rest’

Question 25

The aims of clinical management of stable CAD

Answer 25

-control symptoms (relieve symptoms of acute attacks)
-reduce ischaemic burden (prevent or reduce the freq of anginal ishaemic)
-improve prognosis (by slowing progression of the underlying atherosclerotic coronary pathology)

Question 26

what approaches are there to treat angina?

Answer 26

primary- to prevent getting it i.e diet exercise

secondary- when you already have it

Question 27

What does it mean to have a multifaceted approach

Answer 27

Using multiple therapy techniques:
-lifestyle and risk factor modification (aggressive management of modifiable atherosclerotic CAD risk factors)
-pharmacological therapy (for symptomatic control)
-Myocardial revasculation (PCI, CABG)

Question 28

What are the 4 lifestyle modifications someone with stable angina can make

Answer 28

• diet, smoking cessation, exercise and weight loss

Question 29

what is the basic principles of drug treatment for angina?

Answer 29

increase myocardial oxygen supply and reduce myocardial oxygen demand or both

Question 30

Secondary Prevention for someone with stable CAD

Answer 30

-Blood Pressure Control
-ACEI (for diabetic)
-Diabetes Control
-Aspirin 75 mg daily (antiplatelet)
-Statin (hypolipidaemic)

Question 31

name the 4 drug treatment options of angina

Answer 31

Organic nitrates & nitrites
-Adrenoceptor antagonists (b-blockers)
Calcium channel blockers
Miscellaneous agents- nicorandil, ivabradine, ranolazine