Angina

Question 1

What is the difference between stable and unstable angina?

Answer 1

Stable = symptoms occur with consistent physical exertion that is relieved at rest; this has been occurring for a long period of time

unstable = when angina first occurs; onset of symptoms with less physical exertion; symptoms occur at rest
–> can very easily lead to MI

Question 2

Why might there be a reduced myocardial O2 supply?

Answer 2

1. Coronary artery disease
   - atherosclerosis
   - spasm
   - vasculitis disorders
   - post-radiation therapy
2. Severe anaemia

Question 3

Why might there be an increased myocardial O2 demand?

Answer 3

1. LVH
   - hypertension
   - aortic stenosis
   - aortic regurgitation
   - hypertrophic cardiomyopathy
2. RVH
   - pulmonary hypertension
   - pulmonary stenosis
3. Rapid tachyarrhythmias

Question 4

What are the risk factors for angina?

Answer 4

1. > 45 M or >55 F
2. smoking
3. DM
4. Dyslipidaemia
5. Family history
6. HTN
7. Kidney disease
8. Obesity
9. physical inactivity
10. Prolonged psychosocial stress

Question 5

What are the S+S for angina?

Answer 5

1. chest discomfort
2. Pain experienced in epigastrum, back, neck, jaw
3. Pain subsides with rest within 3-10 minutes
4. precipitated by exertion or emotional stress
5. Increased pulse and BP on exercise
6. Pain may be accompanied by breathlessness, sweating and nausea

Question 6

How is angina diagnosed?

Answer 6

1. CRP - inflammatory marker
   - average is 1-3 mg/L
   - high CRP means increased risk of heart attack
2. ECG - planar or ST depression (reduced O2 = endocardium likely to be damaged)
   - Early ST depression
   - Poor exercise tolerance
   - Exertion arrhythmias or HTN
3. Angiography:
   - only really used when PCI or CABG being considered

Question 7

How is angina managed/treated?

Answer 7

1. LIFESTYLE MODIFICATION
2. GTN (either pill or spray) –> releases NO = vasodilator
3. Aspirin: inhibits thromboxane mediated constriction and platelet aggregation
4. CCB: reduces heart workload by reducing contractility
5. BB: -ve inotropic and chronotropic effects; helps blood vessels relax + improves blood flow
6. Statin: lower level of LDL = increases HDL
   - reduces likelihood of plaque buildup