Angina

Question 1

epidemiology of Angina?

Answer 1

8-14% men and 3-8% women 55-65+. 5 per 1000 in adults 40+ increasing with age.
>40, 49% men, 32 %
symptom of coronary heart disease.

Question 2

aetiology

Answer 2

family history, smoking, alcohol, diabetes, hyperlipidemia, hypertension, obesity and lack of exercise. Compounded by aortic valvular dysfunction and hypertrophic cardiomyopathy.
myocardial ishaemia

Question 3

pathogenesis

Answer 3

Myocardial ischemia due to coronary artery spasm, reduced oxygen carrying capacity of the blood, or coronary artery stenosis

Question 4

natural history

Answer 4

2x likelihood of mortality, reducing with age

plaques in vessels = MI risk

Question 5

manifestations

Answer 5

myocardial O2 demand > O2 supply with greatest disparity during stress, cold weather and exertion. Bouts lasting 6mins

Question 6

symptoms

Answer 6

Heavy, crushing retrosternal discomfort with potential radiation to L arm and jaw (also back, shoulders).
pain lasts 1-5 minutes, relieved by rest, nitro
pain that doesnt change with position, respiration,cough

Question 7

signs

Answer 7

Constricting discomfort in the front of the chest, neck, shoulders, jaw or arms.
Precipitated by physical exertion.
Relieved by rest or GTN in about 5 minutes.

Question 8

complications

Answer 8

MI

Question 9

prognosis

Answer 9

depends on main driver if modifiable. 2x likelihood of mortality, reducing with age

Question 10

DD

Answer 10

Acute myocardial infarction: pain lasts longer than 5 minutes and is not relieved by rest.
Prinzmetal’s angina occurs at rest and exhibits a circadian pattern, with most episodes occurring in the early hours of the morning.
Acute pericarditis: tends to be a more constant pain, which is aggravated by inspiration, lying flat, swallowing and movement.
Musculoskeletal pain: worse on movement but it is the movements rather than general exercise that cause the pain. There may be injury to the chest wall or pain from the thoracic spine. Deep inspiration and rotation are likely to aggravate the pain and there may be local tenderness.

Gastro-oesophageal reflux: often a burning pain, most common on lying down and after meals. Exercise may aggravate the pain, which is relieved by acid/alginate mixtures and much reduced by a course of a proton pump inhibitor.

Pleuritic chest pain: the pain is sharp on deep inspiration. It may occur with infection, especially pneumonia, or with infarction following a pulmonary embolism. There may well be purulent sputum or haemoptysis.
Aortic dissection: causes a more constant pain.
Gallstones can cause acute cholecystitis but the pain is not related to exercise.