Stable Angina Flashcards
Difference between stable and unstable angina?
- when angina is “stable” symptoms are always relieved by rest or glyceryl trinitrate (GTN)
- it is unstable when the symptoms come randomly whilst at rest, and this is considered as Acute Coronary syndrome
Pathophysiology of stable angina?
- narrowing of the coronary arteries reduces blood flow to the myocardium (heart muscle
- during times of high demand such as exercise there is insufficient supply of blood to meet demand
Clinical presentation of angina?
constricting chest pain with or without radiation to jaw or arms
gold standard investigation done for angina?
- CT coronary angiography is the gold standard diagnostic investigation
- involves injecting contrast and taking CT images times with the heart beat to give a detailed view of the coronary arteries, highlighting any narrowing
All patients should have the following baseline investigations for angina:
- 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/hyperthyroid)
- HbA1C and fasting glucose (for diabetes)
There are four principles to management (RAMP):
-Refer to cardiology
(urgently if unstable)
- Advise them about the diagnosis, management and when to call an ambulance
- Medical treatment
- Procedural or surgical interventions
What treatment gives Immediate symptomatic relief?
GTN spray - vasodilation and helps relieve symptoms
Take GTN, then repeat after 5 minutes, if there is still pain 5 minutes after the repeated dose - call an ambulance
Which treatments are given for long term symptomatic relief?
Beta blocker (eg bisoprolol 5mg once daily) or,
Calcium channel blocker (eg amlodipine 5mg once daily)
either or used in combination if symptoms not controlled by one.
other options include:
- long acting nitrates
- Ivabradine
- Nicrorandil
- Ranolazine
What treatments are used for the secondary prevention of cardiovascular disease?
Aspirin (ie 75mg once daily)
Atorvastatin (80mg once daily)
ACE inhibitor
already on beta-blocker for symptomatic relief
Surgical interventions available for treatment of angina?
PCI with coronary angioplasty
Coronary artery bypass graft (CABG)
