Angina Pectoris

Question 1

Angina pectoris

Answer 1

A narrowing of the coronary arteries reduces blood flow to the myocardium (heart muscle). During times of high demand such as exercise there is insufficient supply of blood to meet demand. This causes symptoms the symptoms of angina, typically constricting chest pain with or without radiation to jaw or arms.

Question 2

Stable versus unstable angina

Answer 2

Angina is “stable” when symptoms are always relieved by rest or glyceryl trinitrate (GTN). It is “unstable” when the symptoms come on randomly whilst at rest, and this is considered as an Acute Coronary Syndrome.

Question 3

Gold standard diagnostic investigation in Angina

Answer 3

CT Coronary Angiography

Question 4

First line treatment of angina pectoris

Answer 4

1. sublingual glyceryl trinitrate

2. either a beta-blocker or a calcium channel blocker

Question 5

Second line treatment for angina pectoris

Answer 5

1. if a patient is still symptomatic after monotherapy with a beta-blocker add a calcium channel blocker and vice versa
2. . if a patient is on monotherapy and cannot tolerate the addition of a calcium channel blocker or a beta-blocker then consider one of the following drugs: a long-acting nitrate, ivabradine, nicorandil or ranolazine

Question 6

Why should a beta blocker not be co-prescribed with verapamil?

Answer 6

Remember that beta-blockers should not be prescribed concurrently with verapamil (risk of complete heart block)

Question 7

What are the secondary preventative treatments for angina pectoris?

Answer 7

>

Aspirin (i.e. 75mg once daily)
Atorvastatin 80mg once daily
ACE inhibitor
Already on a beta-blocker for symptomatic relief.