Stable Angina

Question 1

What is the gold standard investigation for Angina?

Answer 1

CT coronary angiogram

Question 2

What baseline investigations should all patients presenting with angina like symptoms have?

Answer 2

Examination 
ECG 
FBC (check for anaemia)
U+E (baseline prior to starting ACEi etc)
LFT (baseline before starting statins)
Lipids
TFT’s
HBA1C

Question 3

How do you manage angina in general terms (think mnemonic)

Answer 3

RAMP

R-Refer to cardiology
A-Advise about diagnosis, management and when to call an ambulance
M-medical treatment
P-procedural/surgical interventions

Question 4

What drug is used to manage the immediate symptoms of Angina?

Answer 4

GTN spray

Spray once sublingual, repeat after 5 mins. If still bad, phone ambulance

Question 5

What medications are used to treat long term symptomatic relief in angina?

Answer 5

Beta blocker (e.g bisoprolol) or calcium channel blocker (e.g amlodipine)

Other options not first line are:
Long acting nitrates (isosorbide mononitrate)
Ivabradine (HCN channel blocker)
Nicorandil (potassium channel activator)
Ranolazine (selective late Na channel inhibitor)

Question 6

What areas can be seen over after a PCI?

Answer 6

Brachial artery scar

Femoral artery scar

Question 7

What scars can be seen after a CABG?

Answer 7

Midline sternotomy scar

Great saphenous vein scar (inner calf)