Angina

Diagnostic features of angina

  • Squeezing, pressing, vice-like pain (NOT burning, sharp, stabbing)

  • +/- Radiation to arm/jaw/neck

  • +/- sweatiness/dyspnoea/nausea/faintness/palpitations

  • Major risk factors - family history, smoker, diabetes, hyper-lipidaemia, untreated hypertension

  • Other risk factors - age > 45 yo, male

Stable versus Unstable angina

  Stable angina Unstable angina
Pathophysiology Fixed narrowing of coronary vessels due to atherosclerotic plaque Dynamic narrowing of coronary vessels due to plaque rupture and thrombus formation
Clinical features Angina worse with exertion 

Angina-like pain with any of the following characteristics:

  • First-onset Canadian Class III/IV angina for < 2 weeks (can walk < 2 blocks or <1 flight of stairs)
  • Pain at rest or at night
  • Prolonged pain > 20 min
  • Pain increasing worse in severity, duration, frequency for < 2 weeks
  • Angina after recent PTCA or CABG
Treatment Aspirin
Long acting nitrates
+/- beta blockers or 
calcium channel blockers
+/- perhexilene		 ADMIT
Aspirin
+/- heparin
+/- IV GTN