Stable angina

Question 1

Angina mechanism

Answer 1

Narrowing of coronary arteries
Reduce blood flow to myocardium
During times of high demand - insufficient supply of blood to meet demand

Question 2

Symptoms of angina

Answer 2

Constricting chest pain
With or without radiation to jaw/arms

Question 3

Stable vs unstable angina

Answer 3

Stable = symptoms relieved by GTN spray / rest
Unstable = symptoms come on randomly at rest –> ACS

Question 4

Angina gold standard investigation

Answer 4

CT coronary angiography

Question 5

Angina initial investigations

Answer 5

Physical exam
ECG
FBC - anaemia
U&Es - prior to ACEi + other meds
LFTs - prior to statins
Lipid profile
Thyroid function tests
HbA1C
Fasting glucose

Question 6

Angina overall management

Answer 6

R - refer to cardiology
A - advise and saftey net
M - medical treatment
P - procedural / surgical interventions

Question 7

Angina immediate symptomatic relief

Answer 7

GTN spray - vasodilation
Repeat after 5 mins x2 - then call ambulance

Question 8

Angina first-line long term symptomatic relief

Answer 8

Beta blocker (bisoprolol 5mg OD)
Or Ca channel blocker (amlodipine 5mg OD)

Question 9

Angina secondary prevention

Answer 9

Aspirin 75mg OD
Atorvastatin 80mg OD
ACE inhibitor
Beta blocker

Question 10

Angina second-line long term symptomatic relief

Answer 10

Isosorbide mononitrate (long acting nitrate)
Ivabradine
Nicorandil
Ranolazine

Question 11

Angina surgical interventions

Answer 11

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