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Angina

Background Knowledge ๐Ÿง 

Definition

  • A clinical syndrome characterised by discomfort or pain in the chest, usually due to myocardial ischaemiaย (reduced blood supply to the heart muscle).

Aetiology

  • Coronary artery disease (CAD): Atherosclerosis of the coronary arteries is the most common cause.
  • Coronary artery spasm (Prinzmetal’s angina).
  • Cardiac syndrome X: Angina with normal coronary arteries on angiography.

Types

  • Stable angina: Triggered by exertion, resolves with rest.
  • Unstable angina: Occurs unpredictably and can persist at rest. Higher risk of progression to myocardial infarction.
  • Prinzmetal’s angina: Due to coronary artery spasm, can occur at rest and is often cyclic.

Clinical Features ๐ŸŒก๏ธ

Clinical features

  • Typically described as heavy, squeezing or tight chest pain.
  • May radiate to the left arm, neck, jaw or back.ย 
  • Associated symptoms: Dyspnoea, nausea, sweating.
  • Duration: Usually < 20 minutes.

Investigations ๐Ÿงช

Investigations

  • ECG: ST-segment depression or T-wave inversion during pain. Normal between episodes.
  • Exercise stress test.
  • Coronary angiography: Gold standard for diagnosing CAD.
  • Blood tests: Troponin, cholesterol, glucose.

Management ๐Ÿฅผ

Management

  • Pharmacological:ย 
    • Nitrates: Short-acting (GTN) for immediate relief; long-acting for prophylaxis.
    • ฮฒ-blockers: Reduce myocardial oxygen demand.
    • Calcium channel blockers: Especially in Prinzmetal’s.
    • Aspirin and statins: For secondary prevention in CAD.
  • Interventional:
      • Percutaneous coronary intervention (PCI) with stent placement.

      • Coronary artery bypass grafting (CABG).

  • Lifestyle modification: smoking cessation, weight management, increase physical activity, limit alcohol consumption.

Prognosis

  • With treatment, many individuals can have good symptom control and reduce risk of myocardial infarction.
  • Regular follow-ups are essential to monitor for disease progression and response to treatment.

Complications

  • Myocardial infarction
  • Heart failure
  • Arrhythmias

Key Points

  • Angina is a clinical syndrome characterised by pain in the chest due to a reduced blood supply to the myocardium.
  • Most commonly caused by narrowing of the coronary arteries due to atherosclerotic plaque formation.
  • Typically associated with dyspnoea, nausea and sweating.
  • Management comprises of lifestyle modifications, pharmacological strategies, and interventional management techniques.

References

Fox, K., Ardissino, D., Morais, J., Pepper, J., Sechtem, U., Simoons, M., Thygesen, K., Buszman, P., Camici, P. G., Crea, F., Daly, C., De Backer, G., Hjemdahl, P., Lopez-Sendon, J. and Marco, J. (2006) ‘Guidelines on the management of stable angina pectoris: executive summary : The task force on the management of stable angina pectoris of the european society of cardiology’, Eur Heart J, 27(11), pp. 1341-1381.

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