Stable Angina - Diagnosis, Investigation and Management

Question 1

What is the definition of stable angina?

Answer 1

”.. a discomfort in the chest and adjacent areas associated with myocardial ischaemia but without myocardial necrosis”

Question 2

What procedure for pain is utilised in the diagnosis of angina?

Answer 2

SOCRATES

Question 3

What features of pain make angina less likely as a diagnosis?

Answer 3

• Sharp/stabbing pain
• Associated body movement
• Very localised
• Superficial with/without tenderness
• No pattern to pain; particularly at rest
• Begins some time after exercise
• Lasting for hours

Question 4

How does silent angina present?

Answer 4

• Breathlessness
• Excessive fatigue on exertion
• Near syncope on exertion

Question 5

Outing the Canadian classification of angina severity

Answer 5

Stage I - symptomatic on significant exertion
Stage II - Slight limitation of ordinary activity, symptoms on extended walking
Stage III - Marked limitation of ordinary activity
Stage IV - always symptomatic

Question 6

What findings on examination of hands may be relevant to SIHD?

Answer 6

Tar stains on fingers

Question 7

What type of obesity may be relevant to SIHD?

Answer 7

Centripetal

Question 8

What examinations of the eyes may be relevant to angina?

Answer 8

Xanthalasma and corneal arcus - signs of hypercholesterolaemia

Question 9

What blood tests should be ordered to aid the diagnosis of angina?

Answer 9

Full blood count
Lipid profile
Fasting glucose 
Electrolytes
Liver function 
Thyroid function