Angina

Question 1

Describe the presentation of stable angina

Answer 1

• retro sternal dull, crushing (pressure) pain [may be described as a burning pain] that is increased with cardiac work and relived by rest.
• they will have a low tolerance to exercise

*similar pain to other conditions

Question 2

Where is the pain in someone with stable angina?

Answer 2

Chest mainly but pain can radiate to:
Jaw
Teeth
Gums
Neck
Left shoulder and arm 
Upper back

Question 3

What are the usual causes of stable angina?

Answer 3

Coronary artery stenosis
Malnourished
Aortic valve stenosis- heart having to work really hard
Hypertrophy cardiomyopathy-too much muscle for cardiac arteries to supply
Severe hypertension

Question 4

What blood tests would you do for someone with stable angina?

Answer 4

FBC (for anaemia)
Cholesterol (high levels-risk factors)
Renal function
Thyroid function (hypo-cause)

Question 5

What investigation would you offer to someone who is suspected of having stable angina?

Answer 5

Bloods,
ECG: might show evidence of previous MI (q waves)/ rhythm abnormalities
Chest X-ray:

Question 6

What tests are there for ischaemia? (6)

Answer 6

Treadmill test
Dobutamine/stress echo- allows you to see the wall motion abnormalities occur earlier than changes are seen on an ECG
Exercise stress echo- same but no drug involved
Myocardial perfusion stress test- use adenosine (vasodilator)- if there is an area of ischaemia you will see a patch of reduced nuclear uptake
MR stress test
PET scanning (unusual)]

Question 7

What is the treatment for stable angina? (9)

Answer 7

Aspirin- blood thinner, prevents platelets sticking to one another
Beta blocker- reduces BP and slows the heart rate
Statin - reduces choleterol, works mainly at night
ACE inhibitor- reduce BP, benefits those with normal BP (ramipril)
Oral nitrate
Nicorandil
CCB- Ca2+ channel blockers-antihypertensive
PCI- percutaneous intervention
CABG- coronary artery bypass surgery

Question 8

What are the two types of PCI used to treat stable angina?

Answer 8

Ballon angioplasty

Stent angioplasty

Question 9

What are the presenting features of unstable angina?

Answer 9

Rapidly deteriorating symptoms
Increasingly frequent, severe, prolonged symptoms over short course of time
Similar location and character of discomfort as for stable angina

Question 10

What is the main cause of unstable angina?

Answer 10

Coronary plaque rupture - accelerated change in coronary plaque - body tries to make a thrombus on top of the plaque and this can completely/ partial occlude the lumen- this causes intermittent symptoms

Question 11

When does Angina occur?

Answer 11

Occurs when oxygen supply to the heart is not sufficient

Limited duration and does not result in the death of myocytes