stable angina

Question 1

what is stable angina a common presentation of

Answer 1

ischaemic heart disease

Question 2

what is the aetiology of stable angina

Answer 2

atherosclerosis

Question 3

outline the pathophysiology of stable angina

Answer 3

narrowing of the coronary arteries reduces blood flow to the myocardium

during times of high demand there is insufficient blood supply to meet demand which causes symptoms of angina

Question 4

what is the clinical presentation of stable angina

Answer 4

tight or crushing central or left sided chest pain

+/- dyspnoea

usually results from exertion and symptoms are relieved by rest (and GTN)

Question 5

what are the investigations used in stable angina

Answer 5

angina is a clinical diagnosis - tests done look at the underlying cause

ECG - may be normal, may have pathological Q waves or ST segment/ T wave abnormality

CT coronary angiography - diagnostic

other imaging: exercise tolerance test, myocardial perfusion scan, catheter angiography

Question 6

what are the lifestyle management strategies used in stable angina

Answer 6

diet and exercise advice
smoking cessation
decrease alcohol intake
BMI of 25 or less

Question 7

what are the medical interventions used in stable angina

Answer 7

immediate symptomatic relief: GTN spray

long term symptomatic relief:
beta blocker or CCB if not tolerated. can be used in combination
other options: long acting nitrates, nicorandil, ivabradine, ranolazine

secondary prevention: aspirin, atorvastatin, ACEi

Question 8

what are the surgical interventions used in stable angina

Answer 8

in proximal or extensive disease: percutaneous coronary intervention with coronary angioplasty

in severe stenosis: coronary artery bypass graft surgery