Overview

• Condition due to narrowing or blockage of coronary arteries, most commonly due to atherosclerosis, resulting in a mismatch between myocardial oxygen supply and demand
• May be Stable Angina or ACS (Unstable Angina, NSTEMI, STEMI)

Making Diagnosis

Clinical Features:

• Angina → retrosternal chest pain, may radiate to left arm, neck or jaw
• Dyspnoea
• Dizziness & Palpitations

Stable Angina → occurs on exertion. Symptoms subside with rest or on administration of GTN

Investigations:

• Contrast-Enhanced CT Coronary Angiogram (1st line imaging for stable angina) → visualise coronary arteries and determine feasibility of intervention using PCI
• Cardiac Stress Testing (ECG whilst exercising)
• ECG → best initial test for chest pain. Pathologic Q waves (negative deflection preceding an R wave) indicate prior infarct.
  • Then do troponin after ECG

Management Plan

• Stable Angina
  • All patients should be on an antiplatelet (aspirin or clopidogrel) and statin
  • GTN Spray → to abort angina attacks
    • Side Effects ⇒ headaches, flushing, dizziness