Stable ischemic heart disease and angina

Question 1

Describe the pathophysiology of stable angina.

Answer 1

mismatch between supply of oxygen and metabolites to myocardium and the myocardial demand for them. Reduction in coronary artery blood flow to the myocardium caused by obstructive coronary atheroma leading to myocardial ischaemia and leading to angina

Question 2

• Discuss the epidemiology and risk factors of stable angina.

Answer 2

Age, gender,family history,
Smoking, lifestyle (exercise and diet) diabetes, hypertension

Question 3

Know the clinical presentation of stable angina.

Answer 3

Pain (tightness, pressure) can radiate to jaw or down arms, discomfort when exerted, cold weather, emotional stress following a heavy meal

Question 4

Discuss relevant investigations of stable angina.

Answer 4

Bloods, CXR, ECG, exercise tolerance test, myocardial perfusion imaging, CT, echo, coronary angiography, invasive angiography

Question 5

drugs to manage angina

Answer 5

statins, ACE inhibitors, aspirin, beta blockers, calcium channel blockers, nitrates, K blockers

Question 6

examination for angina

Answer 6

tar staining on fingers, obesity, xanthalasma and corneal arcus, (with discs on outer bit of eye)
tachycardia, tremor, pan systolic murmur of mitral regurgitation

Question 7

what treatment do you give if angina still impacting your life

Answer 7

Percutaneous coronary intervention- Through needle puncture in radial artery and using the technique we call ballon stents. Crush or squeeze atheromatous material into the vessel wall and leave a megal brace to stent the artery which maintains lumen size

coronary bypass surgery