stable angina

Question 1

What is stable angina

Answer 1

Discomfort in the chest associated with exertion - caused by myocardial ischaemia but without necrosis

Question 2

What is the main cause of angina

Answer 2

Coronary atherome

Question 3

What causes the stable angina symptoms

Answer 3

increased myocardial oxygen demand such as in exertion - the coronary artery is occluded and this leads to ischaemia and the angina symptoms

Question 4

What are the causes of stable angina symptoms

Answer 4

Precipitated by excess myocardial oxygen demand e.g. exertion, cold weather, emotional stress, following heavy meal.

Question 5

Describe the symptoms of stable angina

Answer 5

• Retrosternal pain which feels like a tight band is around them
• Radiates to the neck, jaw or down the arms
• Made worse with exertion
• Rapid improvement with GTN
• Breathlessness on exertion

Question 6

Describe the canadian classification of angina severity

Answer 6

I - ordinary physical activity doesnt cause angina symptoms, only significant exertion causes the symptoms
II - Symptoms on walking 2 blocks or >1 flight of stairs
III - Symptoms on walking 1-2 blocks or 1 flight of stairs
IV - symptoms on any activity

Question 7

How is stable angina diagnosed

Answer 7

ECG - signs of left ventricular hypertrophy - ST depression

Question 8

What is used to influence stable angina disease progression

Answer 8

• statins if total cholesterol >3.5mmol/l
• ACE i if they have increased CV risk
• Aspirin

Question 9

What treatment is given to stable angina for symptomatic relief

Answer 9

• GTN spray
• Beta blocker
• Calcium channel blockers - specificlally diltiazem and verapamil

Question 10

What surgical intervention can be done for stable angina

Answer 10

• PCI - percutaneous coronary intervention - stent can be inserted into the arteries to mantain the lumen size and prevent the occlusion
• CABG - Coronary artery bypass graft - used in patients with >70% occlusion of coronary artery - long saphenous vein harvested and then used to bypass the coronary artery

Question 11

What has to be taken after balooning done for stable angina

Answer 11

Aspirin and clopidogrel to prevent thrombus and atheroma formation