Angina

Question 1

Angina

Answer 1

Systemic manifestation of coronary disease

= manifestation of myocardial ischaemia

Question 2

Angina causes

Answer 2

Decrease in myocardial O2 supply

Increase in myocardial O2 demand

Question 3

Decrease in myocardial O2 supply

Answer 3

Coronary artery disease
- Atherosclerosis, spasm, vasculitis disorders, post-radiation therapy
Severe anaemia

Question 4

Increase in myocardial O2 demand

Answer 4

Left ventricular hypertrophy
- Hypertension, aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy
Right ventricular Hypertrophy
- Pulmonary hypertension, pulmonary stenosis
Rapid Tachyarrhythmias

Question 5

Diagnosis of Angina

Answer 5

History
Character
Location
Radiation (to throat)
Duration
Provocation

Question 6

Angina Diagnosis

Answer 6

ECG during exercise- look at ST segment to see if patient ischaemic
LV motion wall analysis- looks at contractive ability of heart
Perfusion imaging- measures coronary perfusion
Functional Imaging- Isotope perfusion imaging, MR perfusion imaging, Dobutamine stress echo
Anatomical imaging- CT calcium scoring + angiography

Question 7

Exercise ECG

Answer 7

Planar or down-sloping ST depression
Poor exercise tolerance
Early ST depression
Exertional arrhythmias + hypotension

Question 8

Drugs to increase O2 delivery

Answer 8

Increase Coronary flow

- Nitrates, CCBs, Nicorandil, revasc

Question 9

Drugs to reduce HR

Answer 9

BB

Ivabridine

Question 10

Drugs to reduce LV wall tension

Answer 10

BB
Nitrates
Nicroandil
CCBs
Ranolazine

Question 11

Drugs to decrease contractility

Answer 11

BB

CCBs

Question 12

Drugs to modify energy metabolism

Answer 12

Trimetazidine

Question 13

2ndary Angina prevention

Answer 13

Aspirin- all patients
Statins- all patients
ACE inhibitors
P2Y12 receptor antagonist (clopidogrel)- all patients after PCI or if aspirin intolerant

Question 14

Percutaneous Coronary intervention

Answer 14

Coronary catheterization
Coronary angioplasty- balloon catheter
Stent
More cost affective than CABG

Question 15

Coronary Artery Bypass graft

Answer 15

Used to treat CHD

Diverts blood from clogged arteries to improve BF + O2 supply

Question 16

Choice of Revasc Procedure

Answer 16

Coronary anatomy
patient choice
procedural risk
symptomatic benefit
repeat revascularisation
prognostic benefit

Question 17

PCI vs. CABG

Answer 17

PCI more cost effective

Question 18

CABG survival advantage

Answer 18

Diabetes
Age >65
Complex 3VD or LMS