Cardiology 2 Stable Angina

Lecture Outline

I. Patterns of Angina
A. Stable angina
B. Unstable angina
C. Prinzmetals angina
II. Medical Management of Stable Angina
A. Acute management
B. Chronic management
C. Cocaine-induced angina
III. Non-Medical Management of Stable Angina
A. Stress testing
B. Interventional therapy
1. PTCA
2. CABG

Patterns of Angina

1. What is the classic description of anginal chest pain?

2. What non-pain symptoms are often associated with angina?

3. What is the pattern of stable (typical) angina?

4. What is the typical EKG change associated with stable angina, and what does this indicate?

5. What are the differences between the characteristics of stable angina and acute coronary syndromes (ACS)?

Acute Coronary Syndromes

Stable Angina
(Unstable Angina or MI)
Occurs at rest?
Predictable?
Pathophysiology
Relieved by nitroglycerin?

6. What is Prinzmetals angina (variant angina)?

Solid Internal Medicine Copyright 2011, Doctors In Training.com LLC, All Rights Reserved 1
Acute Management

7. What is the drug of choice for acute stable angina?

8. How does nitroglycerin improve anginal symptoms?

9. Why are nitrates contraindicated for use in combination with phosphodiesterase inhibitors such as sildenafil?

10. What other two classes of drugs can be used to treat acute stable angina?

11. What risk factor modifications can prevent progression of atherosclerosis?

Quick Review

12. What is the classic description of anginal chest pain?

13. What symptomatic/historical features suggest stable angina, as opposed to unstable angina?

14. What ST segment changes are seen with stable angina, unstable angina, and acute MI?

15. A 55-year-old man with stable angina is seen for an annual physical first thing on Monday morning. He
reports that he had an episode of his usual angina yesterday while climbing the stairs at church, but it
resolved rapidly with sublingual nitroglycerin, and now he is completely pain-free. What would you expect his
EKG to show today?

Solid Internal Medicine Copyright 2011, Doctors In Training.com LLC, All Rights Reserved 2
Chronic Medical Management

16. How do -blockers treat angina?

17. How do calcium channel-blockers treat angina?

18. In what patients would you use a long-acting nitrate for angina?

19. Why is aspirin used in patients with stable angina?

20. What 5 types of drugs are used in the medical management of chronic stable angina?

21. What drugs are used to treat cocaine-induced angina?

Non-Medical Management

22. What are the different types of cardiac stress testing?

23. What abnormalities on stress echo indicate myocardial ischemia?

24. What is the next step if you have a positive stress EKG?

25. What 2 medications do patients need to be taking after PTCA with stenting?

Solid Internal Medicine Copyright 2011, Doctors In Training.com LLC, All Rights Reserved 3
End of Session Quiz

1. What are the 5 types of drugs used in the medical management of chronic stable angina?

2. When might it be harmful to give a patient aspirin in the setting of acute chest pain?

3. What is Prinzmetals angina, and how is it treated?

4. A 64-year-old man with a history of mild coronary disease says that although he usually has chest pain after
walking his dog for 3 blocks, lately he has been having pain after walking only half a block. The last time he
had pain, the nitroglycerin tablets he carries with him didnt help relieve his pain very much. What is his
diagnosis?

5. What resting EKG findings preclude a patient from having an exercise stress EKG?

6. What findings indicate a positive EKG exercise stress test?

7. What degree of coronary artery disease warrants coronary artery bypass graft (CABG) rather than angioplasty
and stenting?

8. How long must a patient stay on clopidogrel after PTCA?

9. How do nitrates relieve chest pain in stable angina?

10. Why are -blockers contraindicated in patients with cocaine-induced angina or cocaine-induced
hypertension?

Solid Internal Medicine Copyright 2011, Doctors In Training.com LLC, All Rights Reserved 4