ANGINA

Question 1

What is an angina?

Answer 1

A symptomatic reversible myocardial ischaemia

Question 2

What are the two types of angina?

Answer 2

STABLE: induced by effort and relieved by rest or GTN

UNSTABLE: occurs on minimal exertion or at rest, increasing frequency or severity and linked to high risk of MI

Question 3

What are the 3 categories of Angina?

Answer 3

TYPICAL: 3 cardinal features

ATYPICAL: 2 cardinal features

NON-ANGINAL CHEST PAIN: 0-1 cardinal feature

Question 4

What is the pathophysiology of angina?

Answer 4

Reduced blood flow to your myocardium due to CAD, leads to ischaemia

This causes angina when there is an increase in oxygen demand

Question 5

What are the symptoms of Angina?

Answer 5

Recent onset indigestion

Fatigue

Dizziness

Nausea

Dyspnoea

Sweating

Question 6

What are the cardinal features of angina?

Answer 6

Constricting/heavy discomfort to central chest - radiates to jaw, shoulder, neck or arms

Symptoms brought on by exertion

Symptoms relieved within 5min of rest or GTN

Question 7

What are signs of Angina?

Answer 7

Epigastric pain

Stabbing chest pain/pleuritic chest pain

Carotid bruit

Forth heart sound (S4) - unstable angina

Question 8

What causes S4 in Unstable angina?

Answer 8

Myocardial relaxation due to ischaemia

Question 9

What are risk factors of Angina?

Answer 9

Advancing age (45m; 55f)

Smoking

Hypertension

High cholesterol

Diabetes

Lack of physical activity

FHx of early Ischaemic heart disease (>60)

Stress

Cocaine use

Question 10

What are top differentials of Angina?

Answer 10

PE
PULMONARY INFARCTION
PNEUMONIA
PNEUMOTHORAX

Question 11

What are the blood tests for investigating Angina?

Answer 11

FBC: Anaemia
U&E: kidney function
TFT: thyroid function
LFT: liver function
HbA1c: Diabetes

Looks for risk factors and function before medication

Question 12

Which imaging would be requested for Angina? What are the results?

Answer 12

CT CORONARY ANGIOGRAPHY: gold standard - assess stenosis of coronary arteries

ECG: normal but can show ST depression, flat or inverted T waves (signs of old MI)

CXR: excludes other conditions

CT/MRI: excludes other conditions

Question 13

What is the general management of Angina?

Answer 13

Address exacerbating factors

Prevention - stops smoking, dietary advice, control diabetes and hypertension, daily aspirin and consider ACE

Question 14

What is the immediate symptom relief drug for Angina? What are the side effects?

Answer 14

GTN: widens arteries, improved blood flow to and from the heart

SE: headache and low BP

Question 15

What are the long term treatment for Angina?

Answer 15

BETA BLOCKER +/- CCB: atenolol/bisoprolol +/- amlodipine/diltiazem

LONG-ACTING NITRATE: Isosorbide Mononitrate

STATINS: lowers blood cholesterol by blocking HMG-CoA Reductase

Question 16

What are the available surgical procedures for Angina?

Answer 16

PCI + Angioplasty

CABG

Question 17

What do you give if the patient is unable to have a Beta Blocker or a Calcium Channel Blocker?

Answer 17

Give both

OR oral LA Nitrate

OR Ivabradine (slows down heart rate)

OR Nicorandil (vasodilator)

OR Ranolazine (Antianginal Drug)