Angina pectoris

Question 1

Define:

Answer 1

Chest pain or discomfort due to myocardial ischaemia which is brought on by exertion and relieved by rest.

Question 2

Aetiology/risk factors:

Answer 2

Angina pectoris occurs because, during exertion, the demand of the cardiac muscle increases but this demand is not met.

Causes
o Most commonly atherosclerosis
o Rarely: anaemia, AS, tachyarrhythmias, HCM, arteritis, small vessel disease (microvascular angina, cardiac syndrome X)

May also be caused by coronary artery spasm.

Question 3

Symptoms:

Answer 3

• Central chest tightness or heaviness brought on by exertion and relieved by rest
• May radiate to one or both arms, neck, jaw or teeth
• Associated symptoms: dyspnoea, nausea, sweatiness, faintness

Question 4

Signs:

Answer 4

• Dyspnoea

* Tachycardia

Question 5

Investigations:

Answer 5

FIRST LINE: ECG, FBC, lipid profile, fasting glucose

Then: TSH, stress ECG (gold standard), stress myocardial perfusion imaging, stress echo, coronary angiogram

ECG: usually normal, may show ST depression, flat/inverted T waves, signs of past MI

Exclude precipitating factors: anaemia, diabetes, hyperlipidaemia, thyrotoxicosis, temporal arteritis

Question 6

management:

Answer 6

Modify risk factors: stop smoking, encourage exercise, weight loss, control hypertension, diabetes, hyperlipidaemia

For stable angina
o Beta blocker e.g. atenolol
o Calcium channel blockers e.g. amlodipine
o Nitrates e.g. isosorbide dinitrate

If poor response to medical therapy, can do percutaneous transluminal coronary angioplasty (PTCA)

PCI or CABG if unresponsive

Question 7

What are beta blockers contraindicated in?

Answer 7

Asthma
Acute heart failure 
Cardiogenic shock 
Bradycardia 
Heart block