Myocardial Ishaemia (Angina)

Question 1

What is Angina?

Answer 1

Angina is described as a chest pain caused by ischemia.

Question 2

What causes Angina?

Answer 2

Angina is caused by atherosclerotic plaques and contraction which lead to a lack of blood supply to the myocardium leading to a release of K+,H+ and adenosine in the poorly supplied tissue.

Question 3

What are the 3 classifications of Angina?

Answer 3

Stable Angina
Unstable Angina
Prinzmetal’s Angina

Question 4

When does Stable Angina occur?

Answer 4

Stable Angina occurs when there is an increased demand of blood/oxygen to the myocardium during physical exertion but this cannot be met.

Question 5

When does Prinzmetal’s Angina occur?

Answer 5

This occurs during early morning or late nights at rest caused by coronary artery spasm leading to narrowing and occlusion.

Question 6

What symptoms are experienced with Angina?

Answer 6

With Angina there is a crushing pain that can radiate from the chest to the neck, jaw and down the arm.

Question 7

What are the treatment aims when managing someone with Angina?

Answer 7

The treatment aims are based around symptom relief/ prevention, improve QoL and reduction in risk of cardiovascular events.

Question 8

What 6 drugs are used in the treatment of Angina? (Give examples)

Answer 8

Short/ Long acting nitrates (GTN/ Isosorbide mononitrate)
Beta Blockers (Atenolol)
CCBs (Diltiazem)
Ivabradine
Nicorandil
Ranolazine

Question 9

What drug would be initiated for the rapid relief of symptoms during an episode of angina?

Answer 9

GTN would be used to rapidly relieve symptoms.

Question 10

What are the 2 initial drugs options for the regular treatment of Angina?

Answer 10

Beta blockers and CCBs are used for the regular treatment of Angina.

Question 11

If the initial drug options are contraindicated what are the other 4 options?

Answer 11

Long acting nitrates
Ivabradine
Nicorandil
Ranolazine

Question 12

Patients with angina are at risk of cardiovascular events, what secondary prevention should be offered?

Answer 12

Anti-platelet treatment - Aspirin 75mg or Clopidogrel 75mg
Statins

Question 13

For patients with both Angina and DM what should be offered and why?

Answer 13

ACE inhibitors should be offered as they widen blood vessels, have anti-inflammatory, anti-clotting and protective effects on blood vessels.