IHD: Angina

Question 1

Define Angina

Answer 1

Symptomatic reversible myocardial ischaemia (inability to provide adequate blood supply to myocardium)

Stable: induced by effort, relieved by rest
Unstable: increasing frequency or severity, occurs on minimal exertion or at rest
Decubitus: precipitated by lying flat

Question 2

Aetiology of angina

Answer 2

Atheroma, atherosclerosis 
Anaemia 
Coronary artery spasm 
Aortic stenosis 
Tachyarrhythmia 
HOCM 
Arteritis

Question 3

Symptoms of angina

Answer 3

Chest pain

1. constricting/heavy discomfort to the chest, radiates to j/n/s/a
2. on exertion
3. relieved by 5 minutes rest or GTN

3 = typical 
2 = atypical 
0-1 = non-anginal 

Dyspnoea, N+V, sweatiness, faintness, fatigue
Precipitation by emotions, cold weather, heavy metals

Question 4

Signs of angina on examination

Answer 4

hypoxia
Tachycardia
Pansystolic murmur
Bi-basal rales
Carotid bruit 
Diminished peripheral pulses 
RF: xanthoma, xanthelasma, tar staining

Question 5

Investigations for angina

Answer 5

1st line: CT coronary angiography
2nd line: non-invasive functional imaging (looking for reversible myocardial ischaemia)
3rd line: invasive coronary angiography

Question 6

Management for angina

Answer 6

Lifestyle/conservative: stop smoking exercise, dietary advice, HTN and diabetes control

Aspirin (75mg) + Statin
Beta blocker or CCB
Long-acting nitrates

Question 7

complications of angina

Answer 7

Ischaemic cardiomyopathy/HF
MI 
Sudden cardiac death 
Stroke
Peripheral arterial disease