Angina

Question 1

Investigations for angina

Answer 1

Exercise testing
V/Q scan
CT angiography
Angiography

Question 2

Pros of exercise testing for angina

Answer 2

Cheap
Reproducible
Risk stratification

Question 3

Cons of exercise testing for angina

Answer 3

Poor diagnostic accuracy

Sub maximal test

Question 4

Pros. Of V/Q scan for angina

Answer 4

Non invasive
Pharma logical stress in less mobile patients
More precise than ETT
Risk stratification

Question 5

Cons of V/Q scan for angina

Answer 5

Radiation

False positives & negatives

Question 6

Pros of CT angiography for angina

Answer 6

Non invasive

Anatomical data and risk stratification

Question 7

Cons of CT angiography for angina

Answer 7

Radiation
Less precise than angiography
Cost

Question 8

How is angiography done?

Answer 8

Sheath inserted into artery
Catheter advance from wrist or groin
X Ray contrast agent onjected
Video fluoroscopy recorded images

Question 9

Pros of angiography in angina

Answer 9

“Gold standard”
Anatomical data and risk stratification
Flow-on angioplasty

Question 10

Cons of angiography for angina

Answer 10

Radiation 
Contrast (renal dysfunction, rash, nausea)

Question 11

First line treatment of stable angina

Answer 11

GTN spray

Question 12

Second line treatment of angina

Answer 12

Beta blocker or calcium channel blocker

Question 13

Angina treatment if patient cannot tolerate beta blockers and calcium channel blockers

Answer 13

Long acting nitrate 
Or 
Ivabradine 
Or 
Nicorandil 
Or 
Ranolazine

Question 14

When do you consider adding a third anti-anginal

Answer 14

If symptoms not adequately controlled on 2
AND
Patient is waiting for revascularisation or revascularisation is not an option

Question 15

When do you offer CABG to stable angina patients?

Answer 15

Symptoms not controlled by optimal medical treatment
AND
Revascularisation is considered inappropriate
AND
PCI is not appropriate

Question 16

When do you offer PCI to stable angina patients?

Answer 16

Symptoms not controlled by optimal medical treatment
AND
Revascularisation is considered inappropriate
AND
CABG is not appropriate

Question 17

What does GTN spray do?

Answer 17

Dilates coronary afteries and increases blood flow to the heart

Question 18

Clinical features of angina

Answer 18

Passing, squeezing tightness on chest 
Radiates to back, neck, jaw, teeth 
On exertion, stress, cold wind, after meals 
Relieved by rest 
Patient has risk factors

Question 19

Factors which make patients suitable for revascularisation

Answer 19

Multi vessel disease (diffuse or local)
Left main disease
Diabetes
Co-morbidities

Question 20

Indications for angiography

Answer 20

Severe symptoms

High risk

Question 21

Factors which make patients suitable for revascularisation

Answer 21

Multi vessel disease (diffuse or local)
Left main disease
Diabetes
Co-morbidities

Question 22

Indications for angiography

Answer 22

Severe symptoms

High risk

Question 23

What kind of drug is nicorandil?

Answer 23

Potassium channel activator