Angina pectoris

Question 1

What is angina pectoris

Answer 1

chest pain/discomfort due to coronary heart disease

Question 2

How common is it

Answer 2

> 1.4 mill in UK

- 2% prevalence, 1 in 1000 incidence

Question 3

Who does it affect

Answer 3

• 1 in 7 men over 65yrs

- 1 in 10 women over 65yrs

Question 4

What are the causes

Answer 4

• Narrowing coronary arteries –> atheroma
• Atherosclerosis –> SOBOE
• Decreasing walking distance
• RARELY - valve disease, hypertrophic obstructive cardiomyopathy or hypertensive heart disease i.e. supply to heart muscle restricted)

Question 5

What are the risk factors for angina

Answer 5

Smoking, alcohol, obesity

Question 6

What are the symptoms of angina

Answer 6

• heavy/tight/gripping/dull chest pain –> central/ retrosternal –> R to jaw + L arm
• Mild ache to severe pain
• Sweating + fear, SOB, nausea, restlessness, tired

Question 7

What are the characteristics of stable, unstable and noctural angina

Answer 7

STABLE

• Exertional esp after meals + in cold weather
• Pain fades w/in mins –> some ‘walk through pain’

UNSTABLE
- Recent worsening (<24hrs -1month), at rest

NOCTURNAL
- Wakes pt - provoked by vivid dreams = critical CAD

Question 8

What are the signs of angina

Answer 8

• Usually no findings
• 4th heart sound may be heard
• Angiogram shows collateral vessels
• Signs anaemia + hyperlipidaemia (corneal arcus)

Question 9

What is a DDx

Answer 9

PE

Question 10

What investigations would you perform

Answer 10

• resting ECG –> should be norm (Q wave ^ = prev MI | ST depression + T wave inversion = ischaemia)
• Exercise ECG
• Echocardiogram - ventricular wall involvement
• CT coronary angiography - Dx CAD + exclude other causes
• Coronary angiography

Question 11

What treatment is the for angina

Answer 11

MEDICAL

• Prognostic - aspirin, statins (>4.8mmol/L cholesterol), ACEi (if HTN, HF, CKD, DM, prev MI)
• B-blockers, Ca channel blockers = 1st line
• Symptomatic = GTN spray (glyceryl trinitrate)

SURGICAL

• PCI - percutaneous coronary intervention
• PTCA - percut transluminal coronary angioplasty - dilate stenosis using balloon
• CABG - autologous veins/ateries anastomosed to ascending aorta + native coronary As distal to stenosis