Angina Pectoris

Question 1

What are the symptoms of angina?

Answer 1

• chest pain
• heavy/tight/
• central / retrosternal
• radiates to jaw and left arm
• mild ache to severe
• sweating
• SOB

Question 2

What are the features of classical angina?

Answer 2

chest pain that is provoked by physical exertion, after meals and in cold windy weather.
Pain fades with rest within minutes.
Some can “walk through the pain”

Question 3

What are the features of decubitus angina?

Answer 3

Chest pain when lying down.

It is associated with impaired left ventricle function due to severe coronary artery disease.

Question 4

What are the features of nocturnal angina?

Answer 4

Nocturnal angina is chest pain that occurs at night.
It may wake the pt from sleep.
provoked by vivid dreams.
Occurs in patients with critical coronary artery disease.
Also due to coronary vasospasm.

Question 5

What are the features of variant (prinzmetal’s) angina?

Answer 5

Variant (prinzmetal's) angina is chest pain without provocation.
Usually at rest.
Due to coronary artery spasm.
Occurs more in females than males.
There is ST elevation during pain.

Question 6

What are the features of cardiac syndrome X (aka microvascular angina)?

Answer 6

Unlike with other types of angina, the angiogram of microvascular angina is normal. The larger coronayry arteries are normal however the smaller vessels are narrowed. leading to decreased blood supply.

Question 7

What is unstable angina?

Answer 7

unstable angina is worsening angina, with increased frequency , that is unpredictable and occurs at rest.

Question 8

On examination what are the signs of angina?

Answer 8

anaemia
thyrotoxicosis
hyperlipidaemia - corneal arcus, xanthelasma, tendon xanthoma.

Question 9

What investigations are done to diagnose angina?

Answer 9

1) resting ECG (normal between attacks, during attack ST depression or T wave inversion)

2) Exercise ECG
- Cardiac scintigraphy (myocardial perfusion scans at rest and exercise)

3) CT coronary angiography (to diagonose CAD and exclude other causes e.g. PE)
4) CV MRI
5) Coronary angiography (in pt considered for revascularisation)

Question 10

How is angina managed?>

Answer 10

1) Prognostic therapies:
- ASPIRIN 75mg OD
- STATIN if total cholesterol >4.8mmol/L

2) Symptomatic treatment:
- GTN spray (used before activity/to relieve chest pain)

3) Surgery :
- Percutaneous coronary intervention (PCI)
- Coronary artery bypass graft (CABG)