Unstable Angina

Question 1

Risk Factors

Answer 1

Non-modifiable:
- Age
- Sex (Males)
- Family History of IHD
Modifiable
- Smoking
- Hypertension
- Hyperlipidaemia
- Obesity
- Sedentary Lifestyle
- Cocaine

Question 2

Pathophysiology

Answer 2

Deterioration of stable angina
- Plaque prone to rupture = prothrombic state, platelet adhesion + accumulation = progressive luminal narrowing
In unstable angina the plaque has a necrotic centre + ulcerated cap + thrombus = PARTIAL OCCLUSION

Question 3

Aetiology

Answer 3

Atherosclerosis

Question 4

Signs and Symptoms

Answer 4

Same as stable angina but pain at rest and not relieved by GTN spray
“Impending sense of doom”
Pain radiating to both arms, jaw, shoulders, and back
LeVine’s sign
Tachycardic
Diaphoresis
Fatigue
Nausea + epigastric pain

Question 5

Diagnosis

Answer 5

FIRST LINE = ECG - ST depression + T wave inversion when patient is in pain
FBC - anaemia
Cardiac enzymes - Troponin normal
GOLD STANDARD = CT angiography

Question 6

What risk score is used to see the RISK of CVD in next 10 years

Answer 6

QRISK3

Question 7

Acute Treatment

Answer 7

MONAC
Morphine
Oxygen (if SaO2 < 90%)
Nitrates - GTN spray
Aspirin (300mg) + Clopidogrel (75mg)
Then GRACE SCORE

Question 8

Long term Treatment

Answer 8

Beta Blocker (Propranolol)
Aspirin (75mg) LIFE + Clopidogrel 12 MONTHS
Statin - Atorvastatin (80mg)
ACE-I - Ramipril