Stable angina

Question 1

What is the difference between “stable” and “unstable” angina?

Answer 1

Stable angina:

• Occurs on exertion
• Always relieved by rest or GTN

Unstable angina:
- Occurs randomly at rest

Question 2

What is the gold standard diagnostic investigation for angina?

Answer 2

CT coronary angiogram (which will require a referral to cardiology)

Question 3

What are the three aims of medical management in angina?

Answer 3

1) Immediate symptomatic relief
2) Long term symptomatic relief
3) Secondary prevention of cardiovascular disease

Question 4

Which medication(s) are used for immediate symptomatic relief in angina

Answer 4

GTN spray

Question 5

How would you advise a patient to use GTN spray?

Answer 5

• Use GTN spray when chest pain starts
• Repeat after 5 minutes if required
• If there is still pain 5 minutes after the repeat dose, call an ambulance

Question 6

Which medication(s) are used for long term symptomatic relief in angina?

Answer 6

• Beta blocker, e.g. atenolol
• Calcium channel blocker, e.g. amlodipine

Other options may be considered by a specialist. These include: isosorbide mononitrate (long acting nitrate); nicorandil (potassium channel activator); ranolazine

Question 7

Which medication(s) are used for secondary prevention of cardiovascular disease in angina?

Answer 7

4 A’s:

• Aspirin
• Atorvastatin
• ACE inhibitor
• Atenolol (the patient should already be on a beta blocker for long term symptomatic relief)

Question 8

Which procedural/surgical interventions can be used in managing angina?

Answer 8

• Percutaneous coronary intervention (PCI)

- Coronary artery bypass graft (CABG)