Angina Pectoris

Question 1

What are the three main features of angina?

Answer 1

1) constriction/heavy discomfort to the chest, jaw, neck, shoulders or arm
2) symptoms brought on by exertion
3) symptoms relived within 5 mins rest or GTN

Question 2

What is angina?

Answer 2

Symptomatic, reversible myocardial ischaemia - occurs due to insufficient oxygen supply to meet the demands of the heart

Question 3

Precipitants of angina?

Answer 3

Exercise
Emotion
Cold weather
Heavy metals

Question 4

What are the associated signs and symptoms of angina?

Answer 4

Chest pain 
Shortness of breath 
Nausea
Sweaty 
Faint

Question 5

What are the features that make angina less likely?

Answer 5

Continuous pain
Pleuritic pain
Palpitations 
Dizzy
Tingling

Question 6

Possible causes of angina

Answer 6

Atheroma
Hypertrophic cardiomyopathy
Aortic Valve Disease
Increased oxygen demand e.g. heart rate, blood pressure, LVH and valve disease
Decreased oxygen supply e.g. coronary vasomotor tone, anaemia, low oxygen saturations

Question 7

What are the types of angina?

Answer 7

Stable - brought on by exertion and relieved by rest
Unstable - comes on during minimum exertion/rest
Decubitas - lying down
Varient - coronary artery spasm

Question 8

Investigating patients with ?stable angina

Answer 8

ECG - usually normal (+ exercise ECG)
Blood tests - FBC, U&Es, TFTs, lipids and cholesterol
Chest X-Ray
Angiography and ECHO if atypical angina or first event of typical angina

Question 9

How is angina managed?

Answer 9

Address the exacerbating factors 
e.g. anaemia, tachycardia. thyrotoxicosis 
Secondary prevention
PRN symptom releif 
Anti-anginal medication 
Revascularisation

Question 10

What is the secondary prevention for IHD?

Answer 10

Lifestyle modifications 
- stop smoking, exercise, give dietary advice. optimise hypertension and control diabetes 
75mg aspirin
Decrease hyperlipidaemia 
ACEI is diabetic

Question 11

What is the PRN symptom relief for angina?

Answer 11

GTN spray/sublingual tablets

- repeat after 5 mins if needed

Question 12

What anti-anginal medications are available?

Answer 12

First line
- beta-blockers (atenolol) and/or calcium channel blockers (amlodipine)
Second line
- long acting nitrates (isosorbide mononitrate)
- ivabradine
- ranolazine
- nicorandil

Question 13

When is revascularisation needed in angina, and how can it be performed?

Answer 13

Considered when optimal medical therapy proves inadequate
Percutaneous coronary intervention (PCI) - requires DAPT 12 months follow-up
CABG - more sucessful