Angina

Question 1

What is angina?

Answer 1

Chest pain on exertion due to narrowing of the coronary vessels, causing ischaemia.

Question 2

What are the symptoms of stable angina?

Answer 2

On exertion:

• Cardiac chest pain
• +- radiation to the jaw or arm

Question 3

How is stable angina relieved?

Answer 3

Rest

Question 4

What is the gold standard investigation?

Answer 4

CT coronary angio

Question 5

What investigations should be done as baseline?

Answer 5

• Physical examination
• ECG
• Profile (anaemia, UsEs prior to ACEi/other med, LFTs prior to statin)
• Lipid profile
• Thyroid function testing
• HbA1C and fasting glucose

Question 6

What are the four principles of SA management?

Answer 6

RAMP

• Referral to cardiology
• Advice (education and when to call an ambulance)
• Medical management
• Procedural/surgical intervention

Question 7

What medical management groups is used for stable angina?

Answer 7

• Immediate symptom relief
• Long term symptom relief
• Secondary prevention of cardiovascular disease

Question 8

What immediate symptom relief is available?

Answer 8

PRN glyceryl trinitrate

Question 9

How does a GTN spray work?

Answer 9

1- Converts to nitric oxide (a vasodilator)
2- Activates guanylyl cyclase, creating cGMP
3- Activates myosin light chain phosphatase
4- Smooth muscle relaxation

Question 10

When are nitrates CI?

Answer 10

Aortic Stenosis

Question 11

How is long term symptom relief achieved?

Answer 11

• Beta-blocker
• Calcium channel blocker
• Both if one is not enough

Question 12

What long term symptom relief might a specialist use?

Answer 12

Nitrates e.g. isosorbide mononitrate

Question 13

What secondary prevention is available?

Answer 13

Four As

• Aspirin 75mg OD
• Atorvastatin 80mg OD
• ACEi
• Already on a Beta-Blocker anyway

Question 14

What procedures/surgery is available for SA?

Answer 14

• PCI
• CABG

*always check for a mid-sternotomy scar in patients who may have coronary artery disease