Case Study: Stable Angina

Question 1

What are the risk factors?

Answer 1

Physical activity
Smoking
Alcohol
Diet
Age

Question 2

What is stable angina?

Answer 2

Pain in the front of the chest
Brought on by physical exertion, stress, cold weather or heavy meals

Question 3

What is the main symptom of MI?

Answer 3

Angina

Question 4

What are the 3 steps for initial management?

Answer 4

1. 1 or 2 anti-anginal drugs
2. Short-acting nitrate
3. Drugs for secondary prevention of cardiovascular disease

Question 5

Describe the 1st step

Answer 5

Other either BB or CBB

Question 6

Why offer a BB first?

Answer 6

Much cheaper

Question 7

Describe 2nd step

Answer 7

GTN spray

Question 8

What is the 999 rule for GTN?

Answer 8

5 min intervals between each one
After 3 uses + pain hasn’t gone = go hospital
= possible heart attack

Question 9

Describe the 3rd step

Answer 9

Aspirin 75mg
ACEi
Statins

Question 10

What is an example of a statin?

Answer 10

Atorvastatin
= most common
= can be taken any time a day

Question 11

What do you tell people when using GTN spray?

Answer 11

Use before planned exertion
Spray once then wait 5 mins
Call an ambulance after 3 doses
Sit down + hold on to something if light-headed

Question 12

What are side effects of GTN spray?

Answer 12

Flushing
Headache
Light-headedness

Question 13

Would you ever increase dose of GTN?

Answer 13

NO

Question 14

If BB isn’t working what do you want to do?

Answer 14

Increase BB to max tolerated dose
Switch to alternative BB
OR change to CCB

Question 15

What may be the problem with propranolol?

Answer 15

Non-selective
= NOT cardio specific

Question 16

What happens if treatment isn’t satisfactory?

Answer 16

Surgery

Question 17

What are the 2 revascularisation options?

Answer 17

CABG
PCI

Question 18

What is a CABG?

Answer 18

Adding in a bypass vein
= avoid blocked artery

Question 19

What is a PCI?

Answer 19

Stent