Stable Angina

Question 1

What are the symptoms of angina?

Answer 1

Constricting chest pain (may radiate to jaw/arms)
Breathlessness
Dizziness
Sweating

Question 2

When is angina stable?

Answer 2

When symptoms are always relieved by rest or GTN

Question 3

What investigation is gold standard in angina?

Answer 3

CT coronary angiogram

Question 4

What does a CT coronary angiogram involve?

Answer 4

Injecting contrast and taking CT images timed with the heartbeat, highlighting any narrowing in the coronary arteries

Question 5

What baseline investigations should be performed for a patient with suspected stable angina?

Answer 5

Physical examination
ECG
FBC
U&Es
LFTs
Lipid profile
TFTs
HbA1c

Question 6

Management of stable angina?

Answer 6

Refer to cardiology
Advise about diagnosis, management and when to call an ambulance
Medical treatment
Procedural interventions

(RAMP)

Question 7

What is the medical management of stable angina?

Answer 7

Immediate symptomatic: GTN spray (as required)

Long-term symptomatic: Bisoprolol 5mg / Amlodopine 5mg

Secondary prevention:

Aspirin
Atorvastatin 80mg
ACE inhibitor
Atenolol (or bisoprolol)

(4As - same as for CVD)

Question 8

How does a GTN spray work and how should it be taken?

Answer 8

Vasodilation of the coronary arteries, increasing blood flow to the myocardium.

Initial dose when symptoms start.
Repeat at 5 minutes.
If still pain 5 minutes after repeat dose call 999.

Question 9

What is the surgical management for unstable angina?

Answer 9

Percutaneous Coronary Intervention (PCI) with coronary angioplasty.
Coronary artery bypass graft (CABG)

Question 10

Describe the procedure of PCI

Answer 10

Insertion of catheter into the patients femoral/brachial artery.

Injection of contrast into the coronary arteries allows visualisation.

Dilation of balloon +/- insertion of a stent.

Question 11

Describe the procedure of CABG

Answer 11

Open chest along sternum (midline-sternotomy)
Take graft vein from patient’s leg (usually great saphenous)
Sewing graft vein onto affected coronary artery to bypass extensive blockage.