Cardiovascular: Angina

Question 1

what is the angina pain caused by?

Answer 1

an insufficient blood supply to the heart muscle

Question 2

what causes angina?

Answer 2

narrowing of coronary arteries (atheroma), CHD, spasm of coronary arteries, cardiac syndrome X.

Question 3

what is stable angina?

Answer 3

occurs predictably with physical exertion or emotional stress

Question 4

what relieves stable angina?

Answer 4

is relieved within minutes of rest, or with a dose of sublingual glyceryl trinitrate

Question 5

what is unstable angina?

Answer 5

new (usually within 24 hours) onset angina, or abrupt deterioration in previously stable angina, often occurring at rest.

NB: Unstable angina usually requires immediate admission, or referral to hospital.

Question 6

what is pizemetal angina?

Answer 6

vasoconstriction (spasms) of the coronary arteries which completely blocks off the supply to the heart muscle

Question 7

how would pizemetal angina show on an ECG?

Answer 7

ST elevation

Question 8

What are some risk factors for angina?

Answer 8

• Increasing age.
• Male sex.
• Cardiovascular risk factors e.g. smoking, diabetes, hyperlipidaemia, hypertension, obesity.
• A family or personal history of established coronary artery disease (for example previous myocardial infarction, coronary revascularization).
• Lack of exercise.
• Cardiac abnormalities e.g. aortic stenosis, hypertrophic obstructive cardiomyopathy.

Question 9

what are clinical features of angina?

Answer 9

• Precipitated by physical exertion.
• Constricting discomfort in the front of the chest, in the neck, shoulders, jaw, or arms.
• Relieved by rest or glyceryl trinitrate (GTN) within about 5 minutes (stable angina).
• Fatigue.
• Dizziness.
• Abnormal sweating.
• Breathing problems.
• Nausea.

Question 10

What factors that make stable angina less likely?

Answer 10

Pain that is:

• continuous or prolonged.
• unrelated to activity.
• brought on by breathing.
• associated with dizziness, palpitations, tingling, or difficulty swallowing.

Question 11

which conditions present in a similar way to angina?

Answer 11

Myocardial infarction.
Prinzmetals angina.
Acute pericarditis.
Musculoskeletal pain.
GORD.
Pleuritic chest pain – pneumonia/PE.
Aortic dissection.
Gallstones.

Question 12

what investigations would you conduct to diagnose angina?

Answer 12

12-lead ECG
CT coronary angiography
FBC
Cardiovascular physical examination

Question 13

if a patient presents with a new onset of angina, which situations would you consider an early referral to a cardiologist?

Answer 13

• previous MI
• ECG abnormality
• New AF with angina
• Heart failure
• murmur

Question 14

what is the treatment for angina?

Answer 14

Sublingual glyceryl trinitarie (GTN) spray for rapid relief of symptoms: can use before performing activities known to cause symptoms of angina.

prescribe:
- beta blocker or calcium channel blocker

Question 15

what advise would you give a patient when they experience angina/chest pain?

Answer 15

• stop and rest
• use GTN spray
• take second dose after 5 mins
• if pain has not eased 5 mins after call ambulance

Question 16

what are some complications of angina?

Answer 16

Stroke. 
Myocardial infarction. 
Unstable angina. 
Sudden cardiac death. 
Anxiety and/or depression.
Reduced quality of life.