angina

Question 1

definition

Answer 1

paroxysmal central chest pain/tightness radiating to jaw or shoulder due to myocardial ischemia

Question 2

characteristics of stable angina?

Answer 2

caused by stress/exertion, constant and predictable, lasts for 15 minutes, and relieved by rest or nitroglycerin.

Question 3

characteristics of unstable angina?

Answer 3

chest pain occurs at rest/ deterioration of previous stable angina, lasts for longer than 15 minutes.

normal troponins and ECG

Question 4

investigations?

Answer 4

CBC (anemia can worsen angina)
coagulation profile (for coronary angio)
troponins
ECG (during attack- ST depression, normal between attacks)
exercise induced stress test will show st depression on ECG

Question 5

tx of stable angina?

Answer 5

BB lower HR and O2 demand
nitroglycerin for immediate angina relief
CCB if BB are contraindicated
give aspirin to lower risk of further cardiovascular events

reduce modifiable risk factors (BP, glucose, weight, smoking, hyperlipidemia)

Question 6

tx of unstable angina?

Answer 6

admit patient
give BB
dual antiplatelets (aspirin-clopidogrel)
LMWH for 48hrs
morphine and nitroglycerin for pain

continue dual antiplatelet for 6-8 months then aspirin for life