Stable Ischaemic Heart Disease and Angina - Presentation and Investigation

Question 1

What is the definition of angina pectoris?

Answer 1

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

Question 2

What causes angina?

Answer 2

A mismatch between supply of O2 and metabolites to the myocardium and the myocardial demand for them

Question 3

What is the commonest aetiology of angina?

Answer 3

Reduction in blood flow to myocardium principally caused by”

Obstructive atheroma
Vasospasm
Coronary inflammation/arthritis

Question 4

What other (less common) causes are there for angina?

Answer 4

• Reduced O2 transport

- Pathological increase in myocardial O2 demand

Question 5

In the diagnosis of angina what is it important to establish first?

Answer 5

Nature of pain

Question 6

Silent angina presents with no chest pain, what other symptoms would be expected?

Answer 6

Breathlessness, excessive fatigue or near-syncope on exertion

Question 7

What features of the eyes can indicate hypercholesterolaemia?

Answer 7

Xanthalasma and corneal arcus

Question 8

What the positive test for angina on ETT?

Answer 8

ST-segment depression on exertion