Stable angina

Question 1

What is stable angina?

Answer 1

It is cardiac chest pain associated with myocardial ischaemia, but not necrosis

Question 2

What is the physiological cause of stable angina?

Answer 2

Mismatch between the demand and supply of blood to cardiac muscle, most commonly caused by reduction in coronary blood flow

Question 3

List the causes of stable angina

Answer 3

obstructive coronary atheroma, coronary artery spasm, coronary inflammation (rare), anaemia, left ventricular hypertrophy and increased O2 demand, or thyrotoxicosis with increased metabolic demand

Question 4

When does the symptoms of stable angina become apparent?

Answer 4

On exertion, big meal, cold weather, stress, anxiety

Question 5

What narrowing causes stable angina?

Answer 5

Lumen narrowing of 70 % or more

Question 6

What are the symptoms of stable angina?

Answer 6

retrosternal chest pain, tight band, heaviness, pressure, radiation to left side mainly, arm, jaw, neck, gets worse on stress and exertion, received on rest and GTN

Question 7

What is the unusual presentation of stable angina?

Answer 7

Dyspnoea on exertion, no pain, excessive fatigue, near syncope, more common in elderly with DM

Question 8

What is the classification system that is used to assess the severity of angina?

Answer 8

Canadian classification of angina severity CCS

Question 9

How many stages are there in angina ?

Answer 9

4 stages

Question 10

What is stage 1 angina ?

Answer 10

Symptoms are present only on significant physical activity

Question 11

What is stage 2 angina?

Answer 11

Symptoms on walking 2 blocks or more than 1 flight of stairs, slight limitation to ordinary activities

Question 12

What is stage 3 angina?

Answer 12

Symptoms on walking 1-2 blocks or 1 flight of stairs, marked limitation to ordinary activities

Question 13

What is stage 4 angina ?

Answer 13

Symptoms on any activity, getting washed, dressed

Question 14

What are the risk factors for stable angina?

Answer 14

Smoking, hyperlipidaemia, diabetes mellitus, hypertension, exercise and diet, age, gendre, family history, genetic factor

Question 15

What are the investigations for angina ?

Answer 15

Bloods (FBC, lipid profile, fasting glucose, electrolytes, liver and thyroid tests), chest X ray, ECG, exercise tolerance test, myocardial perfusion imaging, CT coronary angiography, invasiva angiography

Question 16

What can be observed on ECG on exertion ?

Answer 16

Depression of ST segment due to LVH

Question 17

What is the treatment of angina ?

Answer 17

Control risk factor by BP, DM, cholesterol medication, lifestyle changes, statins, ACE inhibitors, aspirin or clopidogrel, CCB, ik channel blockers, K+ channel blockers, nitrates, revascularisation, percutaneous transluminal coronary angioplasty and stunting, coronary artery bypass surgery

Question 18

When should be coronary bypass surgery performed?

Answer 18

When left main coronary artery is occluded more than 70%, three vessels with significant proximal occlusion, two vessels with proximal occlusion of anterior descending and ejection fraction lower than 50%

Question 19

Which blood vessels can be used for the bypass surgery?

Answer 19

usually long saphenous vein, left internal mammary artery