Stable angina

Question 1

Angina - physiology

Answer 1

• narrowing of coronary arteries
• reduced blood flow to the myocardium
• reduced blood flow when demands are high

Question 2

Stable/Unstable Angina

Answer 2

• stable - symptoms relieved by rest or GTN
• unstable - symptoms come on randomly at rest aka acute coronary syndrome

Question 3

Stable angina - investigations

Answer 3

• CT coronary angiography -> gold standard
• need a physical exam, ECG, lipid profile, thyroid function test

Question 4

Stable angina - management

Answer 4

• R - refer to cardiology
• A- advice diagnosis and management
• M - medical treatment
• P - procedural or surgical interventions

Question 5

Stable angina - medical management

Answer 5

Immediate symptom relief
- GTN spray - vasodilation

Long term symptom relief (one then add another if not working)
- Beta-blocker (bisoprolol 5mg daily)
- Ca channel blocker (amlodipine 5mg daily)

Secondary prevention
- Aspirin (75mg once daily)
- Atorvastatin (75mg daily)
- ACE inhibitor

Question 6

Stable angina - surgical interventions

Answer 6

• percutaneous coronary intervention with coronary angioplasty
• coronary artery bypass graft (open chest for severe stenosis)