Angina

Question 1

Define angina

Answer 1

Chest pain as a result of cardiac ischemia without cardiac necrosis.

Question 2

What are the most common causes of angina

Answer 2

reduced blood flow to myocardium by:

Obstructive coronary atheroma (Very common)
Coronary artery spasm (Uncommon)
Coronary inflammation/arteritis (Very rare)

Question 3

List less common causes of angina

Answer 3

Reduced O2 supply due to anaemia

increased perfusion demand of myocardium due to LVH

Question 4

Main risk factors of angina

Answer 4

Hypertension
Smoking
Age
Male
Hypercholesterolaemia/lipidaemia
Obesity/Diet/Exercise
Family history

Question 5

Clinical presentation of angina

Answer 5

Chest pain/tightness, generally on exertion
May radiate to shoulder, neck, down arm.
breathlessness and/or excessive fatigue on exertion
Near syncope on exertion
Tachycardia
symptoms relieved after exertion

Question 6

Outline other sources of chest pain to be considered/excluded in differential diagnosis

Answer 6

muscular injury - worsens on specific movements etc

Respiratory conditions

• pneumonia, asthma, CF etc - presence of crackles, wheeze, history of illness etc.
• pneumothorax, pleural effusion

Pericarditis and Aortic dissection - felt as sharp stabbing pain, often radiates to between shoulder blades. May get worse on lying down

GI causes - GORD, Oesophageal spasm

Trauma

Question 7

Typical examination findings of angina

Answer 7

Xanthalasma around ayes
Corneal arcus
Hypertensive
Obesity
Smoker
Symptoms of diabetes
possible aortic aneurysm.

Signs of associated conditions

• LVF: heaves
• heart sounds of aortic stenosis/regurg.
• cyanosis
• Tachycardia
• Signs of heart failure such as basal crackles, elevated JVP, peripheral oedema.

Question 8

Investigations for diagnosing angina

Answer 8

ECG - may show signs of previous MI (ST elevation, pathological Q waves) or signs of LV hypertrophy (increased QRS amplitude in chest leads, ST depression)

Exercise tolerance test - ECG in conjunction with exercise to assess symptomatic changes on exertion.

Myocardial Perfusion scan - radionuclide injected into coronary arteries, scan done at rest and stress (exertional or chemically induced). Areas ‘hot’ at rest and ‘cold’ on exertion indicates restricted flow.

CT angiography - assists decision if pharmaco intervention or surgical

Biochemistry - hyperlipidaemia, anaemia, diabetes

Question 9

Why is treatment of angina important?

Answer 9

QOL - exertional symptoms, mobility etc

Potential to lead to MI, embolism.