Case 1: Chest Pain

Question 1

3 features of angina

Answer 1

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

Question 2

What is typical and atypical angina

Answer 2

Typical is all 3.
Atypical is 2 of
1) heavy discomfort to the chest, jaw, neck, shoulders or arms
2) symptoms brought on by exertion
3) symptoms relieved within 5 mins by rest or GTN

Question 3

Precipitants of angina

Answer 3

Cold
Emotion
Exercise
Heavy meals

Question 4

What is stable angina

Answer 4

Induced by effort.
Relieved by rest.
Good prognosis

Question 5

What is unstable angina

Answer 5

Increasing frequency or severity
Occurs on minimal exertion or at rest
Increased risk of MI

Question 6

Other symptoms associated with angina

Answer 6

Dyspnoea
Nausea
Sweatiness
Faintness

Question 7

Causes of anaemia

Answer 7

Atheroma

Rarely: anaemia, coronary artery spasm, valvular heart disease

Question 8

Risk factors for angina

Answer 8

Smoking
Age
HTN
Diabetes 
raised cholesterol
Previous mi 
FH

Question 9

Investigations for angina

Answer 9

ECG (often normal but may show signs of previous MI - ST depression, flat/inverted T waves)
Bloods (FBC, U&E, TFT, lipids, HbA1c)
Echo
CXR
Angiography

Question 10

PRN symptom relief of angina

Answer 10

GTN spray or sublingual tabs

Question 11

Counselling for use of GTN spray

Answer 11

Take when in pain 
Wait 5 mins
Take again if pain still present
Wait 5 mins 
If pain still present call 999

Question 12

Side effects of GTN

Answer 12

Headache
Low blood pressure (dizziness etc)
Flushing

Question 13

How do nitrates (GTN) work?

Answer 13

Release NO

Vasodilation

Question 14

Treatment for stable angina

Answer 14

Beta blocker (atenolol, bisoprolol) or Ca channel blocker (amlodipine)
Long acting nitrates 
Ivabradine
Ranolazine 
Nicorandil (k channel activator)

Question 15

Secondary prevention of cardiovascular disease when have angina

Answer 15

Aspirin
Statins 
ACEi (if diabetic)
Lifestyle advice 
Control HTN and diabetes

Question 16

Why does hyperthyroidism / thryotoxicosis exacerbate angina?

Answer 16

Hyperthyroidism causes tachycardia and HTN

Question 17

Side effects of aspirin

Answer 17

Gastric ulcers
Dyspepsia
Nausea / vomiting

Question 18

Side effects of beta blockers

Answer 18

Bronchospasm
Reduce hypoglycaemia awareness
Fatigue
Cardiac depression /bradycardia

Question 19

Side effects of calcium channel blockers

Answer 19

Flushing
Headaches
Peripheral oedema
Constipation

Question 20

Side effects of K channel activators

Answer 20

Headaches
Nausea / vomiting 
Flushing 
Dizziness 
Abdominal pain
Ulcers

Question 21

ACS protocol

Answer 21

O2 if sats <94%
Morphine
Nitrates 
LMWH
2 anitplatelets (e.g. aspirin &amp; clopidogrel/ticagrelor)

Question 22

Tx for STEMI

Answer 22

If symptoms started >12 hours ago give fondaparinux

If symptoms started <12 hours ago give reperfusion therapy. If can get to PCI within 120mins then do PCI. If cannot get to PCI within 120mins then thrombolyse

Question 23

What cardioprotective drugs do you prescribe after ACS?

Answer 23

Aspirin for life
Ticagrelor / clopidogrel for 12 months 
Beta blocker 
ACEi
High dose statin

Question 24

Pericarditis: bacterial / viral / fungal?

Answer 24

Bacterial - staphylococcus aureus

Question 25

Myocarditis: bacterial / viral / fungal?

Answer 25

Viral; enterovirus, adenovirus, parvovirus b19

Question 26

Endocarditis : bacterial / viral / fungal?

Answer 26

Bacterial and fungal