Cardiology 2 - Stable Angina

Question 1

Define angina

Answer 1

Constricting chest pain on exertion as a result of narrowing of the coronary arteries + reduced myocardial perfusion

Question 2

Define stable angina

Answer 2

Anginal symptoms are always relieved by rest or GTN spray x2

Question 3

Gold standard investigation for angina

Answer 3

Coronary angiography

Question 4

Other essential investigations for angina on top of angiography

Answer 4

Physical examination
ECG
FBC (anaemia worsens symptoms)
UE (prior to starting meds)
LFTs (prior to statins)
Lipids
TFTs
HbA1c, glucose

Question 5

Immediate and long term angina management (1,2)

Answer 5

GTN spray - 2 doses max, second after 5 mins. If no relief, call an ambulance!

Long term

• beta blocker e.g. Bisoprolol 5mg
• calcium channel blocker e.g. Amlodipine 5mg

Question 6

Specialist long term drugs for angina

Answer 6

Isosorbide mononitrate
Ivabradine funny channel inhibitor
Nicorandil potassium channel opener
Ranolazine late sodium channel inhibitor

Question 7

Secondary prevention x 4 for angina

Answer 7

Aspirin 75mg
Atorvastatin 80mg
ACEx
(beta blocker)

Question 8

Surgical interventions x 2 for angina

Answer 8

Percutaneous coronary intervention + angioplasty - for proximal or extensive disease on angiography.

Coronary artery bypass graft if severe stenosis (see classical scars at midline and saphenous vein)