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Signs & Symptoms
Chest pain lasting several minutes |
Chest pain brought on by exertion |
Relief of chest pain with rest or GTN |
Investigations
Resting ECG: |
Exercise ECG: |
Angiography: |
ST depression + T wave flattening or inversion during attacks |
ST depression (>1mm) at low workload indicates severe CAD + angiography |
where diagnosis uncertain |
Case study
A 50-year-old man presents to clinic with a complaint of central chest discomfort of 2 weeks' duration, occurring after walking for more than 5 minutes or climbing more than 1 flight of stairs. The chest discomfort resolves with rest within several minutes. He is obese, has a history of hypertension, and smokes 10 cigarettes a day. His father died from a myocardial infarction at the age of 54 years. On examination, his blood pressure is 144/92 mmHg with a heart rate of 82 bpm. The remainder of his examination is normal. |
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Unstable Angina
Presents with previously diagnosed angina/new onset angina that is progressing:
- more frequent
- longer in duration
- lower in threshold
Can present with rest angina that occurs for more than 20 minutes + occurs within 1 week of presentation |
Management
Symptomatic Treatment: |
Secondary prevention of MI, sudden death + stroke: |
Prophylactic therapy: |
Acute attacks treated with sublingual GTN tablet or spray |
Modification of risk factors (smoking, HTN, diabetes) |
Beta blockers - reduce HR + force of ventricular contraction |
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Aspirin - 75mg daily to reduce risk of coronary events |
CCBs - relax coronary arteries |
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Statins - achieve cholesterol < 5.0 mmol/L |
Nitrates - reduce venous diastolic pressue + dilate coronary arteries |
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Other treatments - nicorandil, ranolazine + ivabradine |
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