stable angina

Question 1

what causes angina

Answer 1

atherosclerosis affecting coronary arteries narrowing the lumen and reducing blood flow to the myocardium

Question 2

investigation with suspected angina

Answer 2

physical exam
ECG
bloods: FBC, U&ES, LFTs, lipid, TFT, HbA1C
cardiac stress testing
CT coronary angiography

Question 3

medical management of angina

Answer 3

immediate symptomatic relief: GTN spray

long-term symptomatic relief: beta blocker, CCB (verapamil or diltiazem)

medications for secondary prevention: 3 As
- Aspirin 75mg
- Atorvastatin 80mg
- ACE inhibitor

Question 4

side effects of GTN

Answer 4

headaches and dizziness

Question 5

what CCB should be avoided if the patient has heart failure

Answer 5

diltiazem
verapamil

Question 6

management if patient on monotherapy and can’t tolerate adding CCB or BB

Answer 6

long acting nitrate- isosorbide mononitrate
ivabradine
nicorandil
ranolazine

Question 7

surgical interventions available

Answer 7

PCI
coronary artery bypass graft (patients with severe stenosis)

Question 8

investigations for patient whom stable angina cannot be excluded based on clinical assessment

Answer 8

1. CT coronary angiography
2. non-invasive functional imaging
3. invasive coronary angiography

Question 9

management if monotherapy CCB or BB is not controlling symptoms

Answer 9

use both CCB and BB
but switch CCB to longer acting dihydropyridine CCB
- amlodipine
- modified release nifedipine