Pain due to partial blockage of a coronary vessel. Can be stable or unstable
- stable angina (more common) – attacks have a trigger (such as stress or exercise) and stop within a few minutes of resting
- unstable angina (more serious) – attacks are more unpredictable (they may not have a trigger) and can continue despite resting
Some people develop unstable angina after having stable angina.
Causes/Factors
Symptoms
- Chest Pain: Pressure, tightness, squeezing, or burning in the chest.
- Pain subsides in stable angina
- Pain Radiation: May spread to the arms, neck, jaw, shoulder, or back.
- Shortness of Breath: Difficulty breathing, especially during exertion.
- Fatigue: Feeling tired, especially with exertion.
Diagnostic Tests
- Physical exam: heart sounds, Heart Failure, blood pressure, BMI
- ECG: usually normal - may show ST Depression or flat or inverted T waves
- Blood Tests: FBC, U&Es, TFTs, lipids, HbA1C
- Echo and CXR to rule out gross defects and differential diagnoses
- Angiography - for typical and atypical angina if the patient does not have a previous episode of proven Ischemic Heart Disease
Management
5 Principles of management - RAMPS
- Refer to cardiology
- Advise them about the diagnosis, management and when to call an ambulance (3 doses of GTN 5 minutes apart with no relief)
- Medical treatment - GTN spray, beta blocker, CCB (avoid with a reduced ejection fracture)
- Procedural or surgical interventions - PCI, CABG
- Secondary prevention - Aspirin (75mg od), Atorvastatin (80mg od), ACEi (if Diabetes Mellitus, hypertension, Chronic Kidney Disease, or Heart Failure are also present), beta blocker (Bisoprolol)
Tip
Look for signs of previous scars - midline sternotomy for CABG, scars around accessible arteries for PCI and inner calves for saphenous vein harvesting
Complications/red Flags
- Heart Attack: Angina may progress to a heart attack if blood flow is completely blocked.
- Unstable Angina: Severe chest pain at rest, indicating an increased risk of heart attack.