Angina & Unstable Angina (UA)

Exam Cram

• Angina is caused by pain from coronary artery ischaemia during times of increased demand (e.g. exercise)

• Presentation: chest pain- radiates to L/R arm or jaw, triggered by exertion & relieved by rest or GTN

• Diagnosis: symptoms + evidence of coronary artery disease (CTCA/ coronary angiogram, previous myocardial infarction)

• Management: 1. Beta blocker & statin, 2. Calcium channel blocker

Outline

Assessment

History

• Exertional chest pain- central dull ache with radiation to jaw & arm

• Improved with rest

• Risk factors: smoking, alcohol, HTN, previous stroke/ myocardial infarction

Examination

• Usually normal

• Tar staining (smoking)

Investigations

• ECG: normal

• Troponin: normal

• Baseline FBC, EUC, CRP & CXR normal

Diagnosis

Diagnostic criteria: NICE- 2/2

1. Chest pain- worse with exertion, radiates & better with rest

2. Evidence of coronary artery disease: CTCA, coronary angiogram or previous Coronary Artery Disease 

Differentials: Unstable Angina , NSTEMI , Pericarditis 

Management

Acute

1. Beta blocker

2. Calcium channel blocker

3. Ivabradine if HR > 75

4. Investigate for coronary artery disease: 

   1. 1. CT Coronary Angiogram

      2. Exercise Testing

      3. Invasive Coronary Angiogram

Long Term

• Statin

Caution with nitrates as develop tolerance. 

References and Resources

Written 2024