Angina

Classification of Angina

Classical angina or typical angina characterized by chest pain:

• • ‘Heavy’, ‘tight’ or ‘gripping’ central or retrosternal radiate to jaw and/or arms.
• • occurs with exercise or emotional stress.
• • Pain eases rapidly with rest or with GTN.

Atypical angina: 2 out of 3

Non-angina chest pain: 1 out of 3 of

spasm =/ bb

Intracoronary acetylcholine may cause coronary spasm. Whilst they have a good prognosis, they are often highly symptomatic and can be difficult to treat. In women with

Investigations (Stable Angina)

• ECG
  • 12 lead ECG: normal between attacks
    • During attack: transient ST-depression, T-wave inversion.
• Cardiac enzymes(Troponin T & I): Normal
• Exercise (Stress) ECG – ST- depression of 2 mm is taken as positive test
• CT – coronary angiography (accurate - noninvasive)
• Non-invasive functional test; coronary calcium index

• Cardiac Catheterization

Need to confirm or exclude CAD

• Medical therapy fails to relieve anginal symptoms
• History and noninvasive testing suggest high-risk coronary anatomy

Stress ECG

Evaluation of patients with known or suspected coronary heart disease (CHD). Diagnosis & risk assessment and prognosis.

Types

• Exercise electrocardiogram (ECG)
• Exercise with imaging
• Pharmacologic stress testing with imaging: physical ability to perform exercise.

Investigations

• 64-slice CTCA; Chest pain with ST changes or Q waves ⇒
• non-invasive functional tests; SPECT, stress echocardiography, stress MRI). ⇒
• Alternative diagnosis/ tests

Algorithm for Management of Patient’s with Stable Angina