Angina

Question 1

What is Angina?

Answer 1

Coronary artery insufficiency leading to intermittent myocardial ischaemia

Question 2

Causes of O2 demand>supply?

Answer 2

INCREASE DEMAND
Increased CO (exercise, stress thyrotoxicosis)
Greater cardiac work required (aortic stenosis, hypertension - due to increase Peripheral vascular resistance)

DECREASED SUPPLY
Stenotic atheromatous disease of coronary arteries
Thrombosis within the coronary arteries
Spasm of normal coronary arteries
Inflammation - arteritis

Question 3

Angina risk factors

Answer 3

Hypertension, Smoking, DM, obesity, hypercholesterolaemia

Age, male, family history

Question 4

What would an ECG of someone with angina look like?

Answer 4

Probably normal
Can have:
- T wave flattening
- T wave inversion
- ST segment depression
- Partial or complete LBBB

Question 5

What tests would you preform ono someone suspected of Angina?

Answer 5

ECG, exercise ECG
Exercise tolerance test
Stress myocardial perfusion imaging
Stress echocardiography
Coronary angiography

Question 6

What is Syndrome X?

and how is it treated?

Answer 6

Patients with:

• Angina
• Positive ECG
• Normal coronary angiography

Normally middle aged women
Treated with nitrates and CCB

Question 7

What drugs do you use to treat angina?

Answer 7

• Aspirin
• b-Blockers (atenolol, bisoprolol, metoprolol, propranolol)
• Calcium channel blockers (nifedipine, diltiazem, verapamil, amlodipine)
• Nitrates (GTN spray)
• Potassium channel openers (Nicorandil)

Question 8

What drugs would you use to treat Hypercholesterolaemia?

Answer 8

• CoA reductase inhibitors (statins) (Simvastatin, pravastatin, atorvastatin)
• Fibric acid derivatives (Clofibrate, gemfibrozil, fenofibrate)
• bile acid sequestrants (cholestyramine)

Question 9

What are the advantages of PTCA?

Answer 9

+ No general anaesthetic needed
+ No need for cardiopulmonary bypass
+ possible even if Pt unfit for CABG
+ Pt with clotting disorders/recent thrombolysis can be treated in emergency
+ If unsuccessful, CABG can still be performed

Question 10

What are the disadvantages and complications of PTCA?

Answer 10

Patients with left main stem disease, multivessel disease or have tortuous vessels are unsuitable

Complications: MI, coronary artery perforation, arrhythmias, dye reactions, haemorrhage or infection

Question 11

What vessels can be used for CABG?

Answer 11

• GREAT SAPHENOUS VEIN
• Left and right internal mammary arteries
• Radial arteries
• (Gastroepiploic and inferior epigastric)

Question 12

What antiplatelets must be taken post PTCA +/- stenting?

Answer 12

• NSAIDs (aspirin)
• Platelet ADP receptor antagonists (clopidogrel)
• Platelet membrane glycoprotein IIb/IIIa receptor inhibitors (abciximab)