Stable Angina

Question 1

What are the pathophysiological causes of myocardial ischaemia resulting in agina symptoms?

Answer 1

Reduced coronary blood flow due to: Obstructive coronary atheroma
Obstructive coronary artery spasm
coronary inflammation (arteritis)
Reduced myocardial 02 due to anaemia
Increased myocarical 02 demand due to thyrotoxicosis, LVH

Question 2

What are the non modifiable risk factors for coronary artery disease?

Answer 2

Age
Sex (male)
Creed ( afrocaribean/southern asian)
Family history
Genetic factors

Question 3

What are the modifiable risk factors for coronary artery disease?

Answer 3

Smoking 
Lifestyle- diet and exercise
Diabetes
Hypertension
Hyperlipidaemia

Question 4

Describe the canadian classification of angina secerity (CCS)

Answer 4

I- no symptoms unless significant exersion
II- slight limitation: symptoms on walking up >2 flights of stairs
III- marked linitation: symptoms walking >1 flight of stairs
IV- symptoms on doing daily tasks i.e getting dressed

Question 5

What type of pain is characteristic of coronary artery disease(anginal pain)?

Answer 5

Tight band/ pressure/ crushing
No ‘pinpoint’
May radiate to left arm or jaw/neck
Relieving factors with GTN spray and/or with rest
Becomes worse with stress such as emotional or physical activity

Question 6

In the eldery and patients with diabetes they may experience no pain but other symptoms such as….

Answer 6

Breathlessness on exertion
Excessive fatigue on exertion
Near syncope/syncope

Question 7

What investigations are used to diagnose coronary artery disease?

Answer 7

Full blood count - glucose, cholesterol, troponin, thyroid and liver tests
CXR - to rule out any other causes of chest pain
ECG
Excessive tolerance test (ETT)
Cardiac perfusion imaging
CT angiography or invasive angiography (but includes radionuclide dye)

Question 8

What features of the presentation make angina less likely?

Answer 8

Sharp/stabbing pain
Been getting worse over days/weeks
Lasting for hours/days
No pattern to pain I.e. doesn’t go away with rest
Very localized
Associated with body movements and respiration I.e. leaning back makes it worse = pleuritic

Question 9

Name some treatment which can be given for coronary artery disease.

Answer 9

Treat risk factors I.e. diabetes, cholesterol, blood pressure, exercise and diet
Medical treatment I.e. statins, CCB’s, ACE inhibitors, beta blockers, K channel blockers, aspirin,
Surgery - percutaneous transluminal coronary angioplasty (PTCA) & coronary artery bypass graft

Question 10

What would a positive test be from the exercise tolerance test?

Answer 10

Typical symptoms + ST depression