angina

Question 1

Q: What is angina pectoris?

Answer 1

A: Angina pectoris is chest pain or discomfort due to transient myocardial ischemia without myocardial necrosis.
Examiner hook: Is there troponin rise? → No

Question 2

Q: Describe stable angina.

Answer 2

Predictable chest pain

Triggered by exertion or stress

Relieved by rest or nitrates

Caused by fixed atherosclerotic plaque

Question 2

Q: Explain the pathophysiology of angina.

Answer 2

A: It occurs when myocardial oxygen demand exceeds oxygen supply, commonly due to atherosclerotic narrowing of coronary arteries.

Question 2

Q: What is unstable angina?

Answer 2

Chest pain at rest or minimal exertion

Increasing frequency/severity

Due to plaque rupture and thrombosis

Part of Acute Coronary Syndrome (ACS)

Question 2

Q: Risk factors for angina?

Answer 2

Hypertension
Diabetes mellitus
Smoking
Dyslipidaemia
Obesity
Family history

(Examiners LOVE linking this to Botswana’s high HTN burden)

Question 3

Q: Typical features of angina pain?

Answer 3

Retrosternal chest pain

Pressure/heaviness/tightness

Radiates to left arm, neck, jaw

Associated with dyspnoea, sweating, nausea

Question 3

Q: How is angina diagnosed?

Answer 3

Primarily clinical diagnosis
ECG (may be normal at rest)
Exercise stress test
Coronary angiography if needed

Question 4

Q: Acute management of angina attack?

Answer 4

Sublingual GTN
Rest
Oxygen if hypoxic

Question 4

Q: Name the main types of angina.

Answer 4

Stable angina

Acute coronary syndrome-NSTEMI,STEMI,unstable angina

Question 5

Q: Long-term management of stable angina?

Answer 5

Lifestyle modification
Antiplatelets (Aspirin)
Statins
Beta-blockers
Nitrates
± Calcium channel blockers

Question 5

Q: Red flags suggesting unstable angina?

Answer 5

Associated hypotension
Pain at rest
Pain >20 minutes
Poor response to nitrates

Question 6

Q: Difference between angina and MI?

Answer 6

Angina MI
Reversible ischemia Irreversible necrosis
No troponin rise Troponin elevated
Relieved by rest Persistent pain

Question 6

Q: How do nitrates relieve angina?

Answer 6

A:
Venodilation → ↓ preload
↓ Myocardial oxygen demand
Coronary vasodilation

Question 7

Q: Role of beta-blockers in angina?

Answer 7

↓ Heart rate
↓ Contractility
↓ Oxygen demand
Avoid in: Prinzmetal angina

Question 8

Q: When are CCBs preferred?

Answer 8

Prinzmetal angina
When beta-blockers are contraindicated

Question 9

Q: Complications of angina?

Answer 9

Myocardial infarction
Heart failure
Arrhythmias
pericarditis

Question 10

Q: Why give aspirin in angina?

Answer 10

Prevents platelet aggregation
Reduces risk of MI