Cardio treatment

Question 1

Define typical angina chest pain (according to NICE)

What is atypical pain?

Answer 1

1. Constricting discomfort in chest/neck/shoulders/Jaw or arms
2. Precipitated on exercise
3. Relieved wihtin 5 min by GTN spray or rest

Atypical is 2 of above; non-anginal chest pain is 1 or none of above features

Question 2

What are the investigation criteria for chest pain of recent onset? Based on cardiovascular risk…

See NICE guideline for definitions of Hi/Lo risk and % score chart

NB male over 65 always > 30% risk, even with non-typical pain

Likewise, man at any age over 30 with typical pain has > 30% risk

Answer 2

<10% look for non cardiac cause

10-30% CT calcium score, if equivocal, do CT coronary angio

30-60% Funcitonal studies e.g. stress echo or MRI perfusion scanning

60-90% Invasive coronary angiography

>90% treat as Angina

Question 3

How do you treat Angina?

Answer 3

1. Beta blocker monotherapy/ diltiazem if bb not tolerated + GTN spray
2. B+C
3. Alternative medication e.g. nicorandil, ivabradine, ranolazine, long acting nitrates as monotherapy or in addition to BB
4. B/C + >1 other; only consider triple if step 3 fails or can’t revascularise