Angina

Question 1

Treatment of acute angina

Answer 1

400micrograms GTN spray, repeat in 5 mins (max of 1200micrograms) OR
600micrograms GTN tablet, repeat in 5 mins (max of 1600micrograms)

Make sure to sit or lay down

If pain persists for >10mins, take 3rd dose and call SAAS

(Ref: etg)

Question 2

Prevention of angina

Answer 2

Beta Blockers [atenolol/metoprolol]
Diltiazem or Verapamil (if contraindications for beta blockers)
Nitrates

If sx persist despite beta blockers –> use Dihydropyridines e.g. amlodipine and nifidipine

(Ref: etg)

Question 3

To prevent tolerance to nitrates, what is the approach to nitrate prescription?

Answer 3

Controlled-release isosorbide mononitrate daily

Gyceryl trinitrate patch worn for less than 14 hours/day
Ref: etg

Question 4

T or F

Survival benefit exists for long term nitrate therapy?

Answer 4

F

Ref: etg

Question 5

1. What are the typical features of angina?

2. DDx

Answer 5

1. retrosternal pain/discomfort, tight or heavy with exertion, relieved by rest.
2. pericarditis
   coronary a. spasm
   msk - costochondritis
   (Ref: Check IHD 2012)

Question 6

Definition of unstable angina

Answer 6

Unstable angina
describes angina that occurs at rest or with rapidly increasing
frequency and severity.
(Ref: Check IHD 2012)