Angina

Question 1

Pathology of angina

Answer 1

mismatch of oxygen supply and metabolic demand
Adenosine (and other ischaemic metabolites cause pain via nerve stimulation)

Narrowing of coronary arteries caused by
- atherosclerosis, thrombosis, spasm etc

Question 2

What risk assessment tool should be used with those at risk of angina

Answer 2

Q risk

Question 3

Presentation of angina

Answer 3

Heavy, central chest pain ON EXERTION
Eases with rest (within 20mins)

Normal examination

Question 4

What’s unstable angina

Answer 4

angina which is unprovoked and/or doesnt go away

Question 5

Investigations for angina

Answer 5

12 lead ECG (ST depression - ischaemia)
FBC, TFT, BM HbA1c, lipids, GFR, troponins
Echo, X ray

CT-coronary arteries - for calcium score
CT angiography if high
?functional testing

Question 6

Treatment of angina - symptomatic relief

Answer 6

GTN - sublingual
Take one, a second after 5 mins, a third 5 mins later
then if no better after another 5 mins go to hospital

Question 7

Treatment of angina - preventative

Answer 7

b blocker
isosorbide mononitrate (long acting)

aspirin, statins