Angina

Question 1

What are the two groups of common causes of angina?

Answer 1

Decreased myocardial oxygen supply or increased myocardial oxygen demand

Question 2

What may cause decreased myocardial oxygen supply leading to angina?

Answer 2

Coronary artery disease or severe anaemia

Question 3

What may cause increased myocardial oxygen demand leading to angina?

Answer 3

Left ventricular hypertrophy (deu to hypertension, aortic valve dysfunction), right ventricular hypertrophy (due to pulmonary hypertension or pulmonary valve stenosis) or rapid tachyarrhythmias

Question 4

How may angina appear on ECG?

Answer 4

There may be a planar or down-sloping ST depression

Question 5

What treatments may be given to increase oxygen supply to the myocardium in angina?

Answer 5

Nitrates, calcium channel blockers, nicorandil (all vasodilators) or revascularisation

Question 6

What treatments may be given to decrease oxygen demand to the myocardium in angina?

Answer 6

Reduce heart rate - beta blockers and ivabridine

Decreased tension of left ventricular wall - beta blockers, nitrates, nicorandil, calciumm channel blockers and ranolazine

Reduced heart contractility - beta blockers and calcium channel blockers

Modify energy metabolism - trimetazidine

Question 7

What are the two different mechanisms of coronary revascularisation surgery?

Answer 7

Percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)

Question 8

Describe percutaneous coronary intervention (PCI)

Answer 8

Involves the insertion of a stent in order to improve blood flow and prevent ischaemia, and this is most cost-effective over CABG

Question 9

Describe coronary artery bypass graft (CABG)

Answer 9

This involves creating a bypass around the blockage using a different artery, such as the internal mammary artery

Question 10

What treatments are given as secondary prevention with angina?

Answer 10

• Aspirin is given to all patients with angina as prophylaxis
• Statins are given to all patients with angina to lower cholesterol levels
• ACE-I is given to patients with angina only if there are other indications
• Clopidogrel –is given to all patients after PCI or if they are intolerant to aspirin
• Glyceryl trinitrate spray in preventing angina attacks (spray in mouth)

Question 11

When is clopidrogrel prescribed?

Answer 11

After PCI and if the patients are contraindicated for aspirin. This is an anticoagulant which prevents further clot formation

Question 12

What is glyceryl trinitrate spray used for?

Answer 12

This is used in acute angina attacks in order to cause vasodilation via NO to treat the acute symptoms by leading to increased perfusion