Angina

Question 1

Stable Angina

Answer 1

Comes due to exercise, stress and is characterised by chest pain. It is due to atherosclerotic plaques which would restrict the oxygen supply and blood flow to the heart.

Question 2

Complications of angina

Answer 2

Stroke
Myocardial Infarction
Unstable Angina
Sudden cardiac death

Question 3

Prinzmetal angina

Answer 3

Due to spasms occurring causing narrowing of the arteries. The difference in this angina is that pain occurs when resting

Question 4

Treatment for prinzmetal angina

Answer 4

Amlodipine

Question 5

Stable Angina acute attacks

Answer 5

Sublingual GTN. Spray 1-2 sprays under the tongue sitting down. This can be repeated after 5 minutes if the pain is still there. Repeated a maximum of 3 times after which an ambulance should be called

Question 6

Long term Stable angina management

Answer 6

BB (Bisoprolol, atenolol, metoprolol or propranolol)
Verapamil or diltiazem are alternatives if BB CI such as in prinzmetal or decompensated HF

Question 7

What to add if BB do not control symptoms of angina

Answer 7

Add CCB

Question 8

What to add if both BB and CCB are CI/ineffective

Answer 8

Long acting nitrates (ivabradine, nicorandil or ranolazine)

Question 9

Nicorandil SE

Answer 9

Skin, mussel, eye and GI ulcerations can occur - stop if these do

Question 10

Nitrates SE

Answer 10

Flushing
Headache
Postural hypotension

Question 11

How do nitrates work in angina

Answer 11

Reduces venous return therefore reduces left ventricular work

Question 12

Nitrates Cautions

Answer 12

Tolerance may develop in patients who are using transdermal or Long acting nitrates
Transdermal patches should be left off for 8-12 hrs but ideally overnight if tolerance is suspected
Isosoribide denigrate MR, the second dose should be given after 8hrs rather than 12

Question 13

GTN tablets expiry

Answer 13

8 weeks when open