Angina

Question 1

What is angina?

Answer 1

Angina is chest pain caused by insufficient blood supply to the heart muscle.

Question 2

What are the types of angina?

Answer 2

Stable angina - occurs with physical exertion or emotional stress. Relived within minutes of rest or with a dose of GTN.

Unstable angina - occurs with very littlle exertion or at rest.

Question 3

What are the clinical features suggestive of typical angina?

Answer 3

Typical angina presents with all 3 of the following:

1. Constricting discomfort in the front of the chest which radiates to neck, shoulders arm or jaw
2. Precipitated by physical exertion
3. Relieved by GTN within 5 minutes

Question 4

How would you diagnose angina?

Answer 4

Clinical diagnosis

Question 5

What is the initial management of angina?

Answer 5

1st line: GTN spray and wait 5 minutes
2nd line: GTN spray and wait 5 minutes
3rd line: Call ambulance if the above does not work

Question 6

What is the long-term pharmacological management of angina?

Answer 6

1st line: BB or CCB
*If using CCB on its own, use non-dihydropyridines e.g. verapmil, diltiazem

2nd line: both BB + CCB (use dihydropyridines)

3rd line: Initiated by specialist - Ivabridine, IMN, nicorandil

Question 7

What are the 2 types of CCBs?

Answer 7

Dihydropyridines: Amlodipine, Nifedipine
Non-hydydroyridines: Verapamil, Diltiazem

Question 8

When would you admit someone which would suggest serious cause of chest pain?

Answer 8

Serious chest pain and:
-RR>30
-Tachycardia >130bpm
-SBP <90 or DBP <50
-O2 sats <92%
-Fever >38.5
-Altered level of consciousness

Those with suspected ACS

A recent history of ACS and develop further chest pain