Stable Angina

Question 1

What is the cause of angina

Answer 1

Narrowing of coronary arteries supplying the heart. This reduces the blood flow to myocardium so during times of high demand there is an insufficient supply of blood.

Question 2

How does angina present

Answer 2

constricting chest pain that sometimes radiates to jaw or arms

Question 3

What is the difference between Stable and Unstable Angina

Answer 3

Stable Angina : symptoms are relieved by rest or GTN

Unstable Angina : symptoms come on randomly while resting ( part of ACS )

Question 4

List the Investigations done when a patient presents with stable angina (Hint : 9)

Answer 4

1- CT coronary Angiography ( to show any stenosis of coronary arteries )
2- Physical Examination ( heart sounds, BMI )
3- ECG
4- Full blood count ( check for anaemia )
5- U&E
6- LFT
7- Lipid profile
8- Thyroid function tests
9- HbA1c and fasting glucose ( check for diabetes )

Question 5

What are the 4 principles for Stable Angina management

Answer 5

R : Refer to cardiology
A: advise about diagnosis, management and when to call ambulance
M: medical treatment
P: procedure or surgical intervention

Question 6

List the Three aims for Stable Angina medical management

Answer 6

1- Immediate Symptomatic relief
2- Long term symptom relief
3- Secondary prevention of CVD

Question 7

What is the Immediate Symptomatic Relief regimen for Stable Angina

Answer 7

GTN ( glyceryl trinitrate ) spray for vasodilation
- If pain is till present after having taken GTN , repeat process after 5 minutes , if pain is still present call ambulance

Question 8

What is the Long Term Symptomatic Relief regimen for Stable Angina

Answer 8

1- Beta Blocker ( Bisoprolol) : 5 mg once a day
2- Calcium channel blocker ( amlodipine ) : 5 mg once a day
3- Other options : long acting nitrates, Ivabradine , Nicorandil , Ranolazine

Question 9

What is the Secondary prevention regimen for Stable Angina

Answer 9

1- Aspirin ( 75 mg once a day )
2- Atorvastatin ( 80 mg once a day )
3- ACE inhibitor
4- already on beta blocker

Question 10

What are the types of surgical interventions for Stable Angina

Answer 10

1- Percutaneous Coronary Intervention with coronary angioplasty ( PCI )
2- Coronary Artery Bipass Graft ( CABG )

Question 11

Explain a PCI with coronary angioplasty procedure

Answer 11

A catheter is inserted into the brachial or femoral artery and up to the coronary artery under X ray guidance. Contrast is injected so that areas of stenosis can be highlighted in X ray. Blood vessel with stenosis will be dilated with a balloon or stent insertion.

Question 12

Explain a CABG procedure

Answer 12

Chest is opened along the sternum and a graft vein taken from patients leg is sewed onto the affected coronary artery to bypass the stenosis.

Question 13

When is a PCI offered to patients

Answer 13

when patients show proximal or extensive disease on CT coronary angiography

Question 14

When is a CABG offered to patients

Answer 14

when patients have severe stenosis

Question 15

What is the disadvantage of undergoing a CABG procedure rather than PCI

Answer 15

CABG procedures recover slower and have a higher complication rate

Question 16

When examining a patient that may have Coronary artery disease where would you check for scars ?

Answer 16

1- midline sternotomy scar on chest
2- arm for brachial artery access
3- pelvic region for femoral artery access
4- leg for harvesting of graft vein

Question 17

Name the vein used for CABG procedures

Answer 17

Great Saphenous Vein