Stable angina

Question 1

Stable angina

Answer 1

• Ischaemia due to fixed atheromatous Stable angina stenosis of one or more coronary arteries
• Angina which occurs predictably at a certain level of activity

Question 2

Unstable angina

Answer 2

Ischaemia caused by dynamic obstruction Unstable angina of a coronary artery due to plaque rupture or erosion with superimposed thrombosis

• Angina (1) that occurs at rest or with minimal exertion, usually lasts more than
  10 min, (2) is severe and new of onset, and/or (3) that occurs with a crescendo pattern – more severe, prolonged, or frequent than previously

Question 3

Myocardial infarction

Answer 3

Myocardial necrosis caused by acute Myocardial infarction
occlusion of a coronary artery due to plaque rupture or erosion with superimposed thrombosis

Question 4

Most common of death in patient with CAD is?

Answer 4

Ventricular arrhythmia

Question 5

Prinzmetal’s variant angina

Answer 5

**Focal spasm ** of an epicardial coronary artery leading to severe myocardial
ischemia. It occurs at rest, and associated with transient ST-segment elevation.

• suspected in young female patient in 30s , transient ST elevation. Manage with ✅ CCB, and ❌never give Beta blockers يزود الضيق.

Question 6

Risk factors:

Answer 6

Most important ➡️ HTN 📍
Worst one ➡️DM 🆙 accelerate atherosclerosis
Most important in intervention ➡️ smoking 🚬

• Hyperlipidemia and Obesity.
• Family history of premature coronary artery
  disease. in female less than 65 , in male less than 55.
  -Age above 45 in men and above 55 in women.
• Sedentary lifestyle.
• Sleep disorders, such as obstructive sleep apnea.
• Chronic kidney disease
  most common cause of death in CKD patient is CAD

Question 7

Typical angina pectoris:
A typical angina pectoris:
Pseudoangina:

Answer 7

1) retrosternal, chest pain
2) occurs after exertion or emotional⬆️
3) relieved by rest and nitroglycerin⬇️
____________________

only two from three characteristics (especially inwomen and diabetics, angina may be atypical in location and not strictly related to provocing factors)

———————————-

Only one or no one out of three characteristics.

Question 8

the most common cause of angina?
Angina equivalent?

Answer 8

Coronary atheroma
——- ——————
SOB , nausea, diaphoresis , fatigue , without chest pain the symptoms relieve with Nitroglycerin

Question 9

Presentation:
Signs & symptoms….

Answer 9

Symptoms:
1) Retrosternal pain➡️ ( diffuse not localized , described as heaviness &pressure & squeezing , lasts typically 2-5 minutes , radiating either shoulder & to both arms , relieved by rest & nitroglycerin
2) Dyspnoe
3) Fatique , faintness
4) Nausea, vomiting
5) sweating
6) Sense of impending doom with MI
Signs
- 3rd & 4th heart sound
- Apical systolic murmur
- pulmonary congestion

Question 10

Work up:stable angina

Answer 10

1) Resting ECG➡️ reversible ST depression with or without T- wave inversion
2) Exercise ECG
3) Myocardial perfusion scanning
4) Stress echocardiography
5) Coronary angiography➡️ definitive diagnostic test ✅

Question 11

Management of stable angina:

Answer 11

Pharmacology
- Antiplatelet:
Aspirin

• Anti- angina:
  Nitrates
  Beta- blockers (cardio-selective “metoprolol, bisoprolol, carvedilol)
• Lipid lowering agent:
  Statins

“ CCBs if Nitrates and B-blockers not effective”

surgery
- revascularisation therapy ( coronary angioplasty & coronary artery bypass, grafting “ CABG” )