Stable angina

Question 1

What happens in stable angina?

Answer 1

Narrowed coronary arteries causing insufficient blood to the heart in times of high demand (e.g. exercise)

Question 2

Presentation of stable angina

Answer 2

Central constricting chest pain

May radiate to jaw or arms

Pain is relieved by rest or GTN (if it wasn’t that would be unstable angina)

Question 3

Investigations in stable angina

Answer 3

ECG

FBC - to look for anaemia
U&Es (before starting ramipril)
LFTs (before starting statin)
Lipid profile
TFTs
HbA1c (for diabetes)

CT coronary angiography is the gold standard diagnostic investigation

• Second line - non-invasive functional testing
• Third line - invasive coronary angiography

Question 4

Management of Stable angina

Answer 4

Refer to cardiology (urgent referral if unstable angina)

Medical management
- GTN spray for ST symptom relief
- Long-term symptomatic relief either with beta blocker or CCB first line
(second line is both)
-Aspirin 75mg, atorvastatin, 
- Consider ACEi/ BB

Surgical management

• Consider if symptoms not controlled with medical management
• CABG
• PCI

Other options for long term symptomatic relief (not first line):

• Long acting nitrates (e.g. isosorbide mononitrate)
• Ivabradine
• Nicorandil
• Ranolazine

Question 5

What is PCI?

Answer 5

Percutaneous insertion of catheter into coronary arteries under X-ray guidance

Balloon dilatation and insertion of a stent

Question 6

What is CABG?

Answer 6

Bypassing the diseased vessel

Great saphenous vein (usually) taken from leg and used as the bypass vessel

Question 7

Where are saphenous vein harvesting sites?

Answer 7

Inner calves

Make sure to look here in the OSCE