Angina

Question 1

What defines stable angina?

Answer 1

Occurs on exertion or with stress
Lasts <10 minutes
Relieved by rest or nitrates

Question 2

What is unstable angina?

Answer 2

New onset/ deterioration of stable angina/ occurs at rest

Question 3

What are some atypical symptoms of angina?

Answer 3

GI discomfort, breathlessness, nausea

Question 4

What ECG changes may indicate previous MI or ischaemia?

Answer 4

Pathological Q waves
LBBB
ST & T wave abnormalities

Question 5

How is angina diagnosed?

Answer 5

Referral to rapid access chest pain clinic

CT coronary angiogram

Question 6

What are the 3 medications for stable angina?

think anti-anginal, short acting nitrate & CVD prevention

Answer 6

Beta blocker or Rate-limiting CCB

GTN

Aspirin

Question 7

What can be given if Beta blocker & CCB are not tolerated?

Answer 7

Isosorbide mononitrate or nicorandil

Question 8

What is a common SE of nicorandil (<50%)

Answer 8

Headache

Question 9

What should you advise someone on GTN?

Answer 9

If symptomatic, take as instructed
Take a second dose after 5 minutes if pain not eased
After another 5 mins ring 999 if pain still present

Question 10

What other medications should be offered?

Answer 10

ACEi (particularly if patient has DM)
Statin
Anti-hypertensive

Question 11

What 5 medications are prescribed for secondary prevention of MI?

Answer 11

1. ACEi
   2 & 3. Dual anti-platelet therapy (aspirin plus clopidogrel)
2. Beta blocker
3. Statin