Angina

Question 1

What is the definition of angina?

Answer 1

Chest pain due to reduced blood flow to the heart

Question 2

What is the epidemiology of angina?

Answer 2

1.2 million men and 900,000 women are living with chronic angina

Question 3

What is the pathology of angina?

Answer 3

• Narrowing of coronary arteries
• = ↓ blood supply and O2 to myocardium
• Stable angina: induced by effort
• Unstable angina/crescendo: angina of increasing frequency/severity with minimal exertion or rest, ↑ risk of MI. MEDICAL EMERGENCIES
• Decubitus angina: caused my lying flat
• Varient (Prinzmetal’s angina): caused by coronary artery spasm

Question 4

What are the risk factors/aetiology for angina?

Answer 4

• Atheroma
• Anaemia
• Tachyarrhythmias
• Small vessel disease
• Emotion
• Cold weather
• Heavy metals
• Diabetes
• Aortic stenosis
• Hyperlipidaemia
• Thyrotoxicosis
• Smoking
• Obesity
• Family history
• ↑ age
• Male
• Diabetes
• Hypertension
• Cardiac abnormalities – aortic stenosis/hypertrophic obstructive cardiomyophathy

Question 5

What are the signs and symptoms of angina?

Answer 5

• Heavy/tight/gripping chest pain centreally/retrosternally whilst exerting – may radiate to neck, jaw or arms, made better with rest/GTN
• Dyspnoea
• Nausea
• Sweatiness
• Faintness

Question 6

What other diseases present similarly to angina?

Answer 6

• Acute MI
• Acute pericarditis
• GI reflux
• Aortic dissection
• Pleuritic chest pain (PE)
• MSK pain

Question 7

What investigations are carried out for suspected angina?

Answer 7

• BP
• Resting ECG
• Exercise ECG
• CT coronary angiography
• FBC
• Glucose
• Cholesterol
• TFTs
• Troponin/cardiac enzymes
• Myocardial perfusion scintigraphy
• Stress echo

Question 8

What are the surgical treatments for angina?

Answer 8

• Coronary artery bypass grafting (CABG)

* Percutaneous transluminal coronary angioplasty (PCTA) – expanding coronary arteries via a balloon

Question 9

What are the pharmacological treatments for angina?

Answer 9

• Statin
• Aspirin
• Beta blockers
• GTN spray
• Long acting nitrates – isosorbide
• Long acting calcium antagonists – amlodipine, diltiazem
• K+ channel activators - nicorandil

Question 10

What are the non pharmacological treatments for angina?

Answer 10

• Smoking cessation
• ↑ weight loss
• ↑ exercise