Stable Angina

Question 1

How is angina caused?

Answer 1

• narrowing of the coronary arteries reduces blood flow to the myocardium .
• During times of high demand (e.g exercise) there is insufficient supply of blood to meet demand.

Question 2

What are the symptoms of angina ?

Answer 2

• constricting chest pain with or without radiation to jaw or arms

Question 3

How do we know if angina is “stable”?

Answer 3

• when symptoms are always relieved by rest or glyceryl trinitrate (GTN).
  -It is “unstable” when the symptoms come on randomly whilst at rest, and this is considered as an Acute Coronary Syndrome.

Question 4

How do we investigate angina ?

Answer 4

• CT coronary angiography (gold standard)

Question 5

How does CT coronary angiography work?

Answer 5

• This involves injecting contrast and taking CT images timed with the heart beat
• Highlight narrowing

Question 6

What baseline investigations are needed prior to CT angiography?

Answer 6

Physical Examination (heart sounds, signs of heart failure, BMI)
ECG
FBC (check for anaemia)
U&Es (prior to ACEi and other meds)
LFTs (prior to statins)
Lipid profile
Thyroid function tests (check for hypo / hyper thyroid)
HbA1C and fasting glucose (for diabetes)

Question 7

What are the four principles of angina management?

Answer 7

R – Refer to cardiology (urgently if unstable)
A – Advise them about the diagnosis, management and when to call an ambulance
M – Medical treatment
P – Procedural or surgical interventions

Question 8

What is the medical management of angina (immediate, long term and secondary prevention)?

Answer 8

• Immediate symptomatic relief- GTN spray (vasodilates) or take GTN and repeat after 5 mins and if there’s still pain -> ambulance
• Long term symptomatic relief-> beta blocker (bisoprolol 5mg once daily) and or calcium channel blocker (amlodipine 5mg once daily)
• secondary prevention->Aspirin (75mg once daily), Atorvastatin (80mg once daily), ACE inhibitor

Question 9

What is the surgical intervention for angina ?

Answer 9

-Percutaneous Coronary Intervention (PCI) with coronary angioplasty
-Coronary artery bypass graft CABG

Question 10

How does Percutaneous Coronary Intervention (PCI) with coronary angioplasty work?

Answer 10

• (dilating the blood vessel with a balloon and/or inserting a stent)
• CT coronary angiography. This involves putting a catheter into the patient’s brachial or femoral artery, feeding that up to the coronary arteries under xray guidance and injecting contrast so that the coronary arteries and any areas of stenosis are highlighted.
• This can then be treated with balloon dilatation followed by insertion of a stent.

Question 11

How does CABG work?

Answer 11

• severe stenosis.
• This involves opening the chest along the sternum (causing a midline sternotomy scar)
  -Taking a graft vein from the patient’s leg (usually the great saphenous vein) and sewing it on to the affected coronary artery to bypass the stenosis.
  -The recovery is slower and the complication rate is higher than PCI.