Angina Pectoris (Angina)

Last updated 20.09.12

 

-  Stable Angina

-  Unstable Angina

-  Prinzmetals Angina

 

Stable Angina

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Features

-  Chest pain occurring during exertion

 

Ix

-  ECG

-  Trop T & CK (CK-MB)

 

Mx

-  Aim to prevent ACS, arythmia or death, increase effort tolerance & prevent S/S

-  Antiplatelet

-  Aspirin 75-300mg PO Daily

-  If intoleratnt to Aspirin: Clopidogrel 75mg PO Daily

-  Beta Blockers

-  If not contraindicated

-  Atenolol 25-100mg PO Daily

-  OR Metoprolol 25-100mg PO BD

-  If contraindicated: Asthma..

-  CCB (Non-dihydropyridine)

-  &/OR Nitrate

-  &/OR Nicorandil

-  If not preventing Angina

-  CCB (Dihydropyridine)

-  &/OR Nitrate

-  &/OR Nicorandil

-  +/- Calcium Channel Blockers (CCB)

-  Dihydropyridine

-  Amlodipine 2.5-10mg PO Daily

-  OR Nifedipine CR 30-60mg PO Daily

-  Nondihydropyridine

-  Diltiazem

-   30-120mg PO TDS

-   OR CR 180-360 PO Daily

-  Verapamil

-   40-120mg PO BD-TDS

-   OR SR 160-180 PO Daily

-  +/- Nicorandil

-  Initially 5mg PO BD

-  Then after 1 week 10-20mg PO BD

-  Nitrates

-  Regular

-  GTN Patch 5-15mg 14hrs/day

-  OR Isosorbide Mononitrate SR 30-120mg PO Daily

-  Prophylaxis

-  GTN 400mcg Spray S/L every 5min (max x3)

-  OR GTN Tablet 600mcg S/L every 5min (max x3)

-  OR Isosorbide Dinitrate 5mg S/L every 5min (max x3)

-  Lipid Lowering Agents (see Hyperlipidaemia)

-  ACEI

 

Unstable Angina

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Features

-  Acute Coronary Syndrome (ACS)

-  Increased freq, duration

-  Chest pain occurring at rest or less exertion than normal

-  Decreased response to medications

-  New onset

 

Ix

-  ECG: ischaemic changes

-  Trop T & CK (CK-MB): not elevated

-  DDx AMI

 

Mx

-  O2 therapy

-  Hospital admission & monitoring

-  Medications

-  Nitrate

-  Beta blockers

-  Aspirin

-  Heparin or clopidogrel

-  Angiography

 

Prinzmetals Angina (Variant Angina)

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Features

-  Coronary artery vasospasm accompanied by ECG changes often occurring in cycles

-  Typically remits spontaneously but may progress to AMI

-  Usualy occurs during period of rest, commonly in early morning

-  In men often associated with CAD

-  In women often associated with migraine headaches

-  2-10% angina pts

 

Assocaited S/S

-  Angina

-  Exercise tolerance usually normal

-  Ventricular aryhtmias

-  Sudden death

-  Absence of risk factors for IHD

 

Ix

-  EST: normal

-  ECG: ST elevation or depression

-  Trop T & CK (CK-MB): may be elevated

-  Angio: normal vessels

-  Can Dx with Ergonivine or Acetylcholine injected causing coronary vasospam

 

Mx

-  CCB or Nitrate

 

 

 

References

 

eTG: Maintenance Therapy of Stable Angina