Angina Flashcards
How common is it?
Of people 55-64 years of age, 8% of men and 3% of women have it, or have had it
Who does it affect?
Men more than women
What causes it?
Insufficient blood supply to heart muscle that causes pain. This is usually due to coronary artery disease. Less commonly, angina is caused by valve disease (for example aortic stenosis), hypertrophic obstructive cardiomyopathy, or hypertensive heart disease.
What risk factors are there?
The same ones for ischaemic heart disease
How does it present?
NICE defines stable angina symptoms as being:
- Constricting discomfort in the front of the chest, in the neck, shoulders, jaw, or arms
- Precipitated by physical exertion
- Relieved by rest or GTN within about 5 minutes
Factors that make a diagnosis of stable angina unlikely: Pain that is: continuous or very prolonged, unrelated to activity, brought on by breathing, associated with dizziness, palpitations, tingling, or difficulty swallowing.
Signs on examination?
Examine CAD risk via history +BMI
Investigations
ECG - changes that are consistent with CAD that may indicate ischaemia or previous infarction include:
- Pathological Q waves (in particular)
- Left bundle branch block
- St-segment and T-wave abnormalities (for example ST-segment depression, T wave flattening, or T-wave inversion)
A normal ECG does not confirm or exclude angina
Treatment
GTN prn
Beta-blocker or Ca channel blocker
Lifestyle changes
Conditions that would present similarly
MI unstable angina Prinzmetals angina dissecting thoracic aneurysm pericardial pain acute congestive heart failure arrhythmias
GI causes (peptic ulcer disease, GORD)
MSK (costochondritis, rib fracture, osteoarthritis, osteoporosis, rheumatoid arthritis)
psychological causes (anxiety, panic attacks, depression)
respiratory causes (PE, pneumothorax, lung tumour)
referred pain from thoracic spine
