Stable Angina

Question 1

What is stable angina?

Answer 1

Narrowing of coronary arteries, reducing blood flow to myocardium.

Question 2

Difference between stable and unstable angina?

Answer 2

Stable is always relieved by rest or GTN spray

Unstable symptoms may come on while at rest

Question 3

Which angina is a types of ACS?

Answer 3

Unstable

Question 4

What brings on stable angina?

Answer 4

High demand of oxygen/blood, symptoms are caused by insufficient supply
Exercise

Question 5

Symptoms of stable angina?

Answer 5

Constricting chest pain

With or without radiation to arm/kaw

Question 6

Gold standard investigation for stable angina?

Answer 6

CT coronary angiography

Injecting contrast

Question 7

Investigations to do on stable angina patient?

Answer 7

• Physical exam
• ECG
• FBC
• U & E’s
• LFT’s
• Lipid profile
• Thyroid function tests
• HbAIC & fasting glucose (for diabetes)

Question 8

Management acronym for stable angina?

Answer 8

RAMP
R-Refer to cardiologist 
A- advise about diagnosis, management
M- Medical management 
P- Procedural or surgical investigations

Question 9

3 aims of medical management?

Answer 9

Short term symptomatic relief
Long term symptomatic relief
Secondary prevention of CVD

Question 10

Immediate symptomatic relief?

Answer 10

• GTN spray as required

- Instruct to take when symptoms start and 5 mins after if required. If still present call an ambulance

Question 11

What does GTN spray do and stand for?

Answer 11

• Vasodilator

- Glyceryl trinitrate

Question 12

Long term symptomatic relief?

Answer 12

Beta blocker (bisoprolol) 5mg once daily 
Calcium channel blocker (amlodipine) 5mg once daily 
Specialists may be considering long acting nitrates

Question 13

What is PCI?

Answer 13

Percutaneous Coronary intervention

Question 14

Two procedural/surgical interventions?

Answer 14

• PCI + coronary angioplasty

- Coronary artery bypass graft

Question 15

What is percutaneous coronary intervention + angioplasty?

Answer 15

Dilating vessel with balloon and then inserting stent

Question 16

Who is PCI offered to?

Answer 16

Patients with proximal or extensive disease

Question 17

Who is offered CABG?

Answer 17

Patients with severe stenosis

Question 18

What is CABG?

Answer 18

Opening chest along sternum, taking graft from great saphenous vein on leg and sewing to affected coronary artery to bypass stenosis

Question 19

PCI is more risky than CABG. True or false?

Answer 19

False

CABG has slower recovery and higher complication rate than PCI

Question 20

When examining a CVD patient which scars imply they have had surgical intervention for stable angina?

Answer 20

• Midline sternotomy
• Scars around brachial/femoral artery
• Along inner calves (saphenous vein harvesting)