Stable angina

Question 1

What is angina?

Answer 1

Pain, tightness, heaviness or constricting discomfort caused by reduced blood flow to the myocardium (heart muscle).

Typically presents in the chest, but can also radiate to the neck, shoulders, jaw, or arms.

Question 2

Two types of angina?

Answer 2

Stable -has a predictable pattern, usually occurring during physical exertion and is relieved within minutes by rest or GTN spray.

Unstable -is more serious and unpredictable. It is considered a type of ACS, and immediate referral to hospital is necessary.

Question 3

What is stable angina?

Answer 3

Typical anginal chest pain is defined by the following 3 features:

Constriction/heavy discomfort to chest that may radiate to the jaw/neck/arm.
Brought on by exertion.
Alleviated by rest (<5 minutes) or GTN spray.
3/3 features = typical angina pain

2/3 features = atypical angina pain

0-1/3 features = non-anginal pain

Question 4

Why does stable angina occur?

Answer 4

Occurs as a result of a mismatch of myocardial oxygen supply and demand. Most commonly, stable angina is due to coronary artery disease.

Coronary artery disease refers to the narrowing of coronary arteries by atherosclerosis and plaque formation. When demand for myocardial oxygen increases with exertion, narrowed coronary arteries cannot meet this increased demand leading to myocardial ischaemia and pain.

Question 5

Causes of stable angina?

Answer 5

Coronary artery disease
Anaemia
Aortic stenosis
Hypertrophic cardiomyopathy

Question 6

Symptoms/signs of stable angina?

Answer 6

Central, constricting chest pain that radiates to neck/jaw/arm.
Exertional chest pain that is relieved on rest/GTN
N+V
Clamminess or sweating

Question 7

IVx for stable angina?

Answer 7

ECG
Bloods
CT coronary angiogram -1st line
Stress echo, cardiac MRI -2nd line

Question 8

Management of stable angina?

Answer 8

Optimise CVS RFs:
- Smoking cessation
- Glycaemic control
- HTN
- Hyperlipidaemia
- Weight loss
- Alcohol intake

GTN -symptom relief, repeat GTN spray if chest pain not stopped after 5mins, if no improvement after 2 doses then go hospital.

Secondary prevention: aspirin 75mg OD and statin 80mg ON.

1st line: BB or CCB (verapamil or diltiazem)
2nd line: BB and CCB (amlodipine or nifedpine)
3rd line: BB and CCB and long-acting nitrate (ivabradine, nicorandil or ranolazine)

Revascularisation with coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) -if sx uncontrolled by meds.