Chronic Coronary Syndrome (Angina Pectoris)

Question 1

What is angina pectoris?

Answer 1

Angina pectoris may be defined as substernal discomfort that is precipitated by exercise but relieved by rest or GTN spray

Question 2

What are the causes of angina pectoris?

Answer 2

The causes of angina include:

• Atherosclerosis
• Anaemia (rare)
• Tachyarrhythmia (rare)

Question 3

What are the precipitants of angina pectoris?

Answer 3

The triggers for angina include:

• Exercise
• Cold weather
• Big meals

Question 4

What types of angina are there?

Answer 4

Stable angina

• precipitated by exercise but relieved by rest
• ST DEPRESSION

Unstable angina (ACS)

• pain at rest, worsening symptoms
• ST DEPRESSION

Decubitus angina

• triggered by lying flat
• ST DEPRESSION

Prinzmetal angina (ACS)

• due to coronary artery spasm
• ST ELEVATION

Question 5

What investigations should be done in to angina pectoris?

Answer 5

Investigations into angina include:

ECG

• for signs of ST depression or ST elevation
• exercise ECG is no longer recommended by NICE guidelines

CT scan

• Coronary Calcium Score (this is measured on CT)

Coronary angiography

Thallium scan

Question 6

What is the treatment for angina pectoris?

Answer 6

Treatment for angina includes:

Conservative:

• modify risk factors, e.g. control cholesterol, control diabetes, smoking cessation advice, weight loss, increase exercise and control hypertension

Medical:

• Nitrates (GTN spray)
• Aspirin
• Beta-blockers (contraindicated in asthma and COPD)
• Ca2+ antagonists (especially if beta-blockers are contraindicated)
• K+ channel activator, e.g. nicorandil

Surgery

• percutaneous transluminal coronary angioplasty
• coronary artery bypass graft (CABG).

Question 7

What are the complications of angina pectoris?

Answer 7

Complication for angina include:

• ACS
• Stroke