Angina

Question 1

What is angina?

Answer 1

It’s a mismatch of supply and demand.
Chest pain as a result of reversible myocardial ischaemia. This usually implies narrowing of one or more of the coronary arteries

Question 2

What are the features of angina?

Answer 2

• Constricting/heavy discomfort to the chest, neck, jaw or shoulders
• Symptoms are brought on by exertion
• Symptoms are relieved in 5 minutes or by a GTN spray

Question 3

Apart from stable and unstable what are 3 other types of angina?

Answer 3

• Crescendo angina
• Decubitus angina
• Variant (Prizmetal angina)

Question 4

What is angina mainly due to?

Answer 4

Atherosclerosis

Question 5

What are the risk factors for angina?

Answer 5

Same as risk factors for atherosclerosis

• Male
• Age - inc after 65
• Smoking
• Family history - only first degree relatives that died young

Question 6

What are the signs of angina?

Answer 6

Sweating and feeling distressed

Question 7

What are the symptoms of angina?

Answer 7

• Central chest tightness or heaviness (like a heavy weight sitting on the chest)
• Pain may radiate to one or both arms, the neck, jaw or teeth
• Relieved by rest or GTN spray
• Details of pain - OPQRST
• Dyspnoea - difficulty breathing (differentiate this from COPD)
• Nausea
• Sweating and feeling faint

Question 8

What may be seen on the ECG in angina?

Answer 8

ST depression or inverted T waves

Question 9

What is an exercise tolerance ECG?

Answer 9

Putting patients on a treadmill and seeing how long they can exercise for as well as monitoring their ECG results

Question 10

Why is an exercise tolerance test not regularly done?

Answer 10

Because most patients are unsuitable for the test i.e can’t walk, very unfit

Question 11

What is a CT scan calcium scoring test?

Answer 11

CT the heart and if there is atherosclerosis in the arteries then the calcium will light up white - if there is significant calcium then this would indicate angina

Question 12

What is the overall management of angina?

Answer 12

1. Reassure
2. Modify risk factors: Stop smoking, Encourage exercise, weight loss. Treat underlying conditions e.g. anaemia, tachycardia.
3. Advice for emergency
4. Medication
5. Revascularization

Question 13

What are the pharmacological treatments for angina?

Answer 13

• Beta blockers
• GTN spray
• Calcium channel blocker
• Aspirin
• Statins