Stable angina Flashcards
What are three features of angina?
- Constricting/heavy discomfort to the chest, neck, shoulders or arms
- Symptoms brought on by exertion
- Symptoms relieved within 5 minutes by rest/GTN
All 3 - Typical angina
2 - Atypical angina
1 - Non anginal chest pain
What are some other precipitants to angina?
- Cold weather
- Emotion
- Heavy meals
Was are some associated symptoms to angina?
- Dyspnoea
- Nausea
- Sweatiness
- Faintness
What are some features you can ask in a history to rule out angina?
- Is the pain continuous?
- Pleuritic pain
- Worse with swallowing
- Pain associated with palpitations
- Dizziness or tingling
What are some causes of angina?
- Atheroma mostly
- Rarely - anaemia, coronary artery spasm, aortic stenosis, tachyarrythmias, HCM, arteritis
What are the 4 types of angina?
- Stable angina - Good prognosis
- Unstable angina - Increasing frequency or severity, occurs on minimal exertion or at rest. Risk of MI.
- Decubitus angina - Precipitated by lying flat.
- Variant angina - Caused by coronary artery spasm (rare)
What investigations do you do on all patients with suspected angina?
- Bloods - FBC, U+E, LFT, TFT, lipids, HbA1C
2. Resting 12 lead ECG - rhythm, heart block, previous MI, ischaemia, HCM
If there is a high likelihood of CAD - what investigation would you do? 61-90%
What about medium? 30-60%
What about low? 10-29%
High - Coronary angiography
Medium - Functional imaging - Stress MRI, echo, myoview
Low - CT calcium scoring. If 0 - no CAD. If score 1-100, give a CT coronary angiography. If above 400, perform coronary angiography.
Should you use exercise ECG for diagnostic purposes?
NO if a patient does not have known CAD.
If they do then you can
What exacerbating factors can be managed in the treatment of angina?
- Anaemia
- Tachycardia
- Thyrotoxicosis
What can you do for secondary prevention of CHD?
- Aspirin 75mg OD (clopidogrel if intolerant)
- Stop smoking, diet advice, optimise diabetes and hypertensive control
- Address hyperlipidaemia
- Consider ACEi especially if diabetic
What can you give for PRN symptomatic relief in angina?
GTN sublingual spray.
Repeat dose if symptoms haven’t gone after 5 minutes, and then call an ambulance 5 minutes after the second dose if still symptomatic.
What anti anginal medication can you give?
- Beta blockers - lowers mortality in high risk patients
- CCB - non dihydropridine (rate limiting)
- Long acting nitrates - need to avoid nitrate tolerance
- Ivabradine - sinus node blocking agent. Rate control when beta blocker not tolerated
- Ranolazine - Alternative to first line drugs
- All patients should be on a statin
When should you consider revascularisation?
- When medical intervention is inadequate
- PCI
- CABG if multi vessel disease
