Angina

Question 1

What is angina pectoris

Answer 1

Symptomatic reversible myocardial ischaemia

Question 2

Angina features

Answer 2

Sharp chest, jaw, neck, shoulder, arm discomfort
Symptoms brought on by exertion
Symptoms relieved within 5 mins by rest/GTN

Question 3

Angina classifications

Answer 3

Typical if all 3 features
Atypical if 2
Non-anginal if 0-1

Question 4

Angina triggers non-exercise

Answer 4

Emotion
Cold weather
Heavy meals

Question 5

Angina types

Answer 5

Stable - effort induced, good prognosis
Unstable (crescendo) - Increasing frequency/severity, occurs on minimal exertion/rest

Variant (prinzmetal) - Caused by CA spasm

Question 6

Angina tests

Answer 6

ECG normal or ST depression
CT coronary angiography is diagnostic

Echo to confirm IHD
Exercise ECG

Question 7

Angina management

Answer 7

GTN PRN, 2nd dose 5 mins, call ambulance 5 mins after 2nd dose if pain still present

Exacerbating factors e.g. anaemia, tachycardia, thyrotoxicosis
2˚ CVD prevention including aspirin 75mg/d

Anti-anginal medications
Revascularisation (PCI/ CABG)

Question 8

Angina medications

Answer 8

1st line: beta-blocker + dihydropyridine Ca blocker e.g. atenolol 50mg BD and amlodipine 5mg OD

Others:
Isosorbide mononitrate
Ivabradine (-vely chronotropic)
Ranolazine (Na+ blocker)
Nicorandil (K+ activator)

Question 9

Vasospastic angina triggers

Answer 9

Cocaine
Amphetamine
Marijuana

Low Mg
Artery instrumentation e.g. angiography