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Angina Pectoris Cheat Sheet by [deleted]

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.
 

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
 
Aspirin - 75mg daily to reduce risk of coronary events
CCBs - relax coronary arteries
 
Statins - achieve choles­terol < 5.0 mmol/L
Nitrates - reduce venous diastolic pressue + dilate coronary arteries
  
Other treatments - nicora­ndil, ranolazine + ivabradine

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