Chest pain and IHD

Question 1

Typical history of IHD

Answer 1

Chest discomfort- pressure, heaviness, tightness and breathlessness. <10 mins. Inclines, cold weather, heavy meals make it worse.

Relieved by nitrates

Question 2

When to be suspicious of aortic dissection

Answer 2

Older patients with hypertension or connective tissue disorders.

Question 3

History of those with aortic dissection

Answer 3

Testing pain, front to back between shoulder blades, associated abdo pain
Loss of consciousness, paralysis or neurological deficit

Question 4

Examination findings in those with aortic dissection and what tests to do to diagnose

Answer 4

Loss of pulses
Unequal BP between arms
Aortic regurgitation murmur

• D/Dimer
• CXR
• Emergency CT aorta

Question 5

3 characteristics of typical angina

Answer 5

Constricting discomfort in the front of the chest or in the neck, jaw, shoulder or arm

Precipitated by physical exertion

Relieved by rest or nitrates within 5 mins

Question 6

Management

Answer 6

Smoking cessation
Medditteranean diet 
Physical exercise
Weight control
BP control
DM optimal control
Influenza vaccine

Question 7

Medical management for angina

Answer 7

GTN spray
Betablocker first line
Dihydropyramidine CCB Second line if BB not tolerated
Combination of BB and CCB

Long cating nitrates (nitrate free period)
Ivabradine
NIcorandil
Non-dihydropyridine CCB

Question 8

Medical management chronic coronary syndrome

Answer 8

Aspirin
Combination aspirin/clopidogrel for very high risk/associated cerebrovascular disease
Addition of low dose rivaroxaban with aspirin for those with CCS at very high risk
PPI for those on aspirin

Question 9

When is revascularisation used

Answer 9

• left main stem disease
• Proximal LAD disease
• 2-3 vessel disease with impaired LV function
• Disease in single remaining coronary vessel
• Coronary artery disease with limiting angina on optimal medical therapy
• Large area of myocardium at risk (>10%) on functional testing