Angina + MI

Question 1

Causes of angina

Answer 1

CHD most commonly

HOCM, valve disease, arrhythmias, anaemia, thyrotoxicosis

Question 2

S+S angina

Answer 2

Pain - episodic, central crushing/ band like, radiating to jaw/ neck/ arms
Precipitated by exertion, cold, emotion + heavy meals
Relieved by rest + GTN spray
Associated with palpitations, sweating, nausea, SOB

Question 3

RF for angina

Answer 3

Smoking, fam hx, hx of CVA/ TIA/ VTE

Question 4

Investigations for angina

Answer 4

Bloods

12 lead resting ECG

Question 5

Non-pharmacological treatment of angina

Answer 5

Smoking cessation 
Treat HTN 
Diet - oily fish, low cholesterol 
Reduce alcohol 
Increase exercise

Question 6

Driving + angina

Answer 6

Group 1 - stop until symptoms controlled if attack was during rest, at wheel or with emotion
Group 2 - inform DVLA + revoked license until symptom free for >6 weeks

Question 7

PRN treatment + SE for angina

Answer 7

GTN 1-2 puffs as needed

SE: flushing, headaches, light headedness

Question 8

Regular treatment for angina

Answer 8

B blocker or Ca channel blocker
2nd line: combine
3rd line: long acting nitrates, nicorandil, ivabradine

Question 9

What is secondary prevention of angina?

Answer 9

Aspirin 75mg OD or clopidogrel if aspirin intolerant
Statins to decrease total cholesterol
ACEi decrease deaths

Question 10

When should angina be referred to cardiology?

Answer 10

Unstable/ rapidly progressing
aortic stenosis + angina 
Angina following MI
Abnormal ECG 
Angina not controlled by 2 drugs 
Strong family hx

Question 11

What is unstable angina?

Answer 11

Pain with no exertion/ at rest

Angina that is rapidly worsening in intensity, frequency or duration

Question 12

When to use surgery for angina + what options are there?

Answer 12

If symptoms not controlled with 2 drugs
Coronary revascularisation with bypass surgery (CABG) or percutaenous intervention (PCI)

CABG better in DM, >65 y/o, left anterior descending artery disease

Question 13

What is prinzmetal/ variant angina?

Answer 13

Angina at rest resulting from coronary artery sparm
ECG shows ST elevation
Ca channel blockers to prevent
GTN spray PRN

Question 14

What is cardiac syndrome X?

Answer 14

Ongoing angina symptoms despite normal coronary angiography

Treat with B blockers/ Ca channel blockers

Question 15

Driving post MI

Answer 15

Group 1: stop driving for 1 week if successfully treated with angioplasty, otherwise for 1 month
Group 2: license revoked, review after 6 weeks

Question 16

Sexual activity post MI

Answer 16

No increased risk - safe to do so around 4-6 weeks after

Question 17

Return to work guide post MI

Answer 17

Sedentary jobs = 4-6 weeks
Light manual = 6-8 weeks
Heavy manual = 3 months

Question 18

Drug treatment post MI

Answer 18

ACEi
Aspirin
Clopidogrel/ ticagrelor for up to 12 months in NSTEMI, 4 weeks in STEMI
B blocker for 12 months (diltiazem/ verapamil if CI)
Statins
Spironolactone if signs of HF

Question 19

Antiplatelet therapy post MI

Answer 19

Aspirin indefinitely
Ticagrelor/ clopidogrel for 12 months in NSTEMI or PCI/ stent
4 weeks only in STEMI

Question 20

What is dressler syndrome?

Answer 20

Develops 2-10 weeks post MI - due to autoantibodies to heart muscle
Recurrent fever + chest pain+ pleural/ pericardial effusion

Treat with steroids + NSAIDs

Question 21

Statin therapy cautions

Answer 21

Inhibit liver enzymes P450
LFTs need checking within 3 months of starting statins + after 12 months
Take at night due to cholesterol being made at night

Question 22

SE of statins

Answer 22

Rhabdomyolysis + muscle breakdown - muscle aches + pains

Question 23

B blockers therapy monitoring

Answer 23

Check HR - caution with bradycardia

Check BP

Question 24

ACEi therapy monitoring

Answer 24

U+Es - can cause postural hypotension + hyperkalaemia

Can cause AKI (also with NSAIDs)