Stable Angina

Question 1

What is the typical history associated with stable angina pectoris?

Answer 1

• Chest pain or discomfort with exertion, relieved by rest or nitroglycerin
• History of coronary artery disease or risk factors (e.g., hypertension, diabetes, smoking)
• Possible radiation of pain to the arm, neck, or jaw

Question 2

What are the key physical examination findings in stable angina pectoris?

Answer 2

• Often normal between episodes
• During an episode: elevated heart rate, increased blood pressure, possible S4 heart sound
• Signs of underlying cardiovascular disease (e.g., carotid bruits, peripheral artery disease)

Question 3

What investigations are necessary for diagnosing stable angina pectoris?

Answer 3

• ECG: may show ST-segment depression or T-wave inversion during an episode
• Exercise stress test or pharmacologic stress test
• Coronary angiography if diagnosis is unclear or for planning revascularization

Question 4

What are the non-pharmacological management strategies for stable angina pectoris?

Answer 4

• Lifestyle modifications: healthy diet, regular exercise, smoking cessation
• Weight management and control of comorbid conditions (e.g., diabetes, hypertension)
• Stress management techniques

Question 5

What are the pharmacological management options for stable angina pectoris?

Answer 5

• Nitrates (e.g., nitroglycerin) for acute symptom relief
• Anti-hypertensives to reduce systemic vascular resistance
• Antiplatelet agents (e.g., aspirin) and statins for cardiovascular risk reduction

Question 6

What are the red flags to look for in stable angina pectoris patients?

Answer 6

• Increasing frequency or severity of chest pain
• Pain at rest or with minimal exertion
• Symptoms suggestive of acute coronary syndrome (e.g., prolonged pain, dyspnea, diaphoresis)

Question 7

When should a patient with stable angina pectoris be referred to a specialist?

Answer 7

• Refractory symptoms despite medical management
• Consideration for revascularization procedures (e.g., PCI, CABG)
• Complex cases requiring specialized cardiology evaluation

Question 8

What is one key piece of pathophysiology related to stable angina pectoris?

Answer 8

• Myocardial ischemia due to an imbalance between oxygen supply and demand
• Typically caused by atherosclerotic plaque in coronary arteries
• Leads to transient chest pain or discomfort with exertion