Angina

Question 1

What is meant by acute coronary syndromes?

Answer 1

Unstable angina
NSTEMI
STEMI

Question 2

What is angina pectoris?

Answer 2

Chest pain
Caused by a mismatch of oxygen demand and supply

Too little supply for the demand

Question 3

What are the main causes of angina?

Answer 3

Impairment of blood flow due to narrowing of coronary arteries

Increased resistance to blood flow, for example L ventricular hypertrophy

Reduced oxygen carrying capacity of blood, for example Anaemia

Question 4

What are the risk factors for angina?

Answer 4

Age
Cigarette smoking
Family history (1st degree relative with MI under 60)
Diabetes mellitus
Hyperlipidaemia
Hypertension
Renal disease
Obesity
Physical inactivity
Stress

Question 5

What are some environmental exacerbating factors of angina?

Answer 5

Exercise

Heavy meals: blood diverted to stomach away from heart

Emotional stress

Question 6

Does angina affect men or women more?

Answer 6

Men

Question 7

How do patients often describe angina?

Answer 7

A tight band, pressure on their chest

Question 8

What are the symptoms of angina?

Answer 8

Chest pain, radiates to L arm and jaw
SOB
Nausea

Question 9

What are the types of angina?

Answer 9

Stable: pain on exertion
Unstable: pain at rest

Prinzmetal’s: coronary artery spasm which reduces blood flow

Question 10

What’s the differential diagnosis of chest pain?

Answer 10

ACS or angina

Pericarditis or myocarditis

PE

Pneumonia

Dissection of aorta

Gastro-oesophageal reflux/ulceration

MSK cause: arthritis, costochondritis

Exclude other causes such as anaemia

Question 11

What treatment for stable angina?

Answer 11

Reduce risk factors (treat diabetes, HTN, lifestyle)

Low dose aspirin 75mg OD

GTN (glyceryl trinitrate): spray or sublingual tabs

Beta blocker (or if not effective Ca Channel blocker

Statin: reduce blood cholesterol

(PCI, CABG)

Question 12

What risk factors should you attempt to reduce in angina patients?

Answer 12

Lose weight
Stop smoking
Exercise more
Reduce cholesterol
Stop drinking alcohol

Control hypertension (ACEi, Ca Ch blockers)
Control diabetes (diet, metformin, etc)

Question 13

What should you do if you suspect someone has unstable angina?

Answer 13

Send to A+E
300mg aspirin
GTN spray

Question 14

What does PCI stand for? What is it?

Answer 14

Percutaneous Coronary Intervention

A surgical procedure that uses a catheter and balloon to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by atherosclerosis.

Question 15

Criteria for having PCI?

Answer 15

Chest pain onset within 12h

PLUS one or more of

ST elevation 2mm or more in 2 consecutive chest leads
St elevation 1mm or more in 2 consecutive limb leads
Dominant R waves
New LBBB

Question 16

What does CABG stand for? What is a CABG?

Answer 16

Coronary Artery Bypass Graft

A surgical procedure where you harvest a blood vessel from the leg (great saphenous vein)and use it to divert blood flow around the obstructed coronary artery, so the heart muscles still receive sufficient blood

The purpose is to restore normal blood flow to that partially obstructed coronary artery.

Question 17

Investigations for angina.

Answer 17

1st line: CT coronary angiography: looks at perfusion of coronary vessels

2nd:
Myoview scan: radioactive tracer to view blood flow
Stress echo: looks at heart under strain
Perfusion MRI: radio-opaque tracer to view blood flow

3rd: invasive coronary angiography

Question 18

What is a stress echo?

Answer 18

Uses ultrasound + contrast to look at the heart under stress

Patient is given a drug called Dobutamine which increases heart rate.

The heart is viewed while this is happening

Question 19

What is a perfusion MRI?

Answer 19

Radio-opaque tracer that shows up ischaemic regions of the heart

Question 20

Why should you check TFTs in angina patient?

Answer 20

Hyperthyroid and hypothyroid increase risk of angina