| What defines new onset effort angina in terms of duration and CCS class? | New onset effort angina of less than 1 month in CCS class II/ III | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 532 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768823342_cardiology_1-6.pdf | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • | 1 | page=1,block=7 | 0.700 | valid |
| What defines stable angina in terms of effort-related pain? | Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 303 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768823342_cardiology_1-6.pdf | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • |
| What type of pain is localized to a point and precipitated by movement of neck or arms? | Pricking or piercing or stabbing type of pain | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 185 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768823342_cardiology_1-6.pdf | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • |
| What increases the likelihood of symptoms being related to coronary artery disease? | Likelihood more if known patient of CAD | • Diffuse retrosternal pain, heaviness or constriction, radiating to arms or neck or back • Associated with sweating • Easily reproduced with post-meal exertion • Consider atypical presentation: Exertional fatigue or breathlessness or profuse sweating or epigastric discomfort Likelihood more if known patient of CAD | 277 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768823342_cardiology_1-6.pdf | • Diffuse retrosternal pain, heaviness or constriction, radiating to arms or neck or back • Associated with sweating • Easily reproduced with post-meal exertion • Consider atypical presentation: Exertional fatigue or breathlessness or profuse sweating or epigastric discomfort Likelihood more if known patient of CAD | 1 | page=1,block=4 | 0.700 | valid |
| What is the term for recent worsening of stable angina to CCS class III? | crescendo | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 502 | definition | 0.940 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768823342_cardiology_1-6.pdf | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • |
| What are the dosages for short-acting and long-acting Metoprolol? | • Short acting: 25-100 mg BD • Long acting: 25 -100 mg OD | Anti-platelets • Aspirin 75 mg OD • Clopidogrel 75 mg OD (if intolerant to aspirin) • Ticagralor 90 mg BD Lipid lowering agents • Atorvastatin: 40-80 mg OD • Rosuvastatin: 20-40 mg OD • Non-statin lipid modifying agents Ace-inhibitor • Ramipril: 2.5-10 mg OD • Enalapril: 2.5-10 mg BD Anti-ischemic: 1. Metoprolol: • Short acting: 25-100 mg BD • Long acting: 25 -100 mg OD 2. Nitrates: • Isosorbide mono-nitare: 20 to 60 mg in 2 devided dose • Nitroglycerine sustained release: 2.6 to 6.5 mg BD 3. Calcium channel blockers: • Amlodipine 5-10mg OD • Verapamil 40-80 mg TDS • Diltiazem 30 to 90 mg TDS 4. Nicorandil: 5-10 mg BD 5. Ranolazine: 500 -1000 mg BD 6. Trimetazidine: 20 mg mg TDS 1. Vrints C et al. ESC guidelines for management of chronic coronary syndrome. European Heart J (2024) 44, 3415-3537 2. | 315 | comparison | 0.920 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768823342_cardiology_1-6.pdf | Metoprolol: • Short acting: 25-100 mg BD • Long acting: 25 -100 mg OD 2. | 1 | page=1,block=16 | 0.700 | valid |
| What symptoms are associated with diffuse retrosternal pain, heaviness, or constriction? | Associated with sweating | • Diffuse retrosternal pain, heaviness or constriction, radiating to arms or neck or back • Associated with sweating • Easily reproduced with post-meal exertion • Consider atypical presentation: Exertional fatigue or breathlessness or profuse sweating or epigastric discomfort Likelihood more if known patient of CAD | 92 | relationship | 0.890 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768823342_cardiology_1-6.pdf | • Diffuse retrosternal pain, heaviness or constriction, radiating to arms or neck or back • Associated with sweating • Easily reproduced with post-meal exertion • Consider atypical presentation: Exertional fatigue or breathlessness or profuse sweating or epigastric discomfort Likelihood more if known patient of CAD | 1 | page=1,block=4 | 0.700 | valid |
| What are the characteristics of pain that lasts hours to days or less than a minute? | Variable location or characteristic | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • Post infarction angina For management: refer to STEMI/ NSTEMI STW ESSENTIAL INVESTIGATIONS 1. Hemogram 2. Urea, Creatinine, Electrolytes 3. Sugar 4. Lipids 5. ECG OTHER INVESTIGATIONS 1. Echocardiography 2. Exercise Treadmill Test 3. Thyroid Function Test 4. Iron profile 5. Uric acid 6. | 2 | summary | 0.890 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768823342_cardiology_1-6.pdf | • Variable location or characteristic • Long lasting (hours to days) or short lasting (less than a minute) • Restricted to areas above jaw or below epigastrium • Localized to a point • Pricking or piercing or stabbing type of pain • Precipitated by movement of neck or arms or respiration STABLE ANGINA Any effort related pain fitting in previous category, relieved by rest or NTG in 1-2 min ACUTE CORONARY SYNDROME • Angina at rest or lasting more than 20 minutes • Recent worsening of stable angina (crescendo) to CCS class III • New onset effort angina of less than 1 month in CCS class II/ III • |
| What are some atypical presentations of chest discomfort in patients with coronary artery disease? | Exertional fatigue or breathlessness or profuse sweating or epigastric discomfort | • Diffuse retrosternal pain, heaviness or constriction, radiating to arms or neck or back • Associated with sweating • Easily reproduced with post-meal exertion • Consider atypical presentation: Exertional fatigue or breathlessness or profuse sweating or epigastric discomfort Likelihood more if known patient of CAD | 195 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768823342_cardiology_1-6.pdf | • Diffuse retrosternal pain, heaviness or constriction, radiating to arms or neck or back • Associated with sweating • Easily reproduced with post-meal exertion • Consider atypical presentation: Exertional fatigue or breathlessness or profuse sweating or epigastric discomfort Likelihood more if known patient of CAD | 1 | page=1,block=4 | 0.700 | valid |
| What are some factors that can potentiate angina and need management? | Anemia, Thyrotoxicosis, Pregnancy, febrille illness - Hypertension, Ventricular hypertrophy, CHF - Tachy or brady-arrhythmia - Drugs : bronchodilators, steroids | 1. Manage factors potentaiting angina - Anemia, Thyrotoxicosis, Pregnancy, febrille illness - Hypertension, Ventricular hypertrophy, CHF - Tachy or brady-arrhythmia - Drugs : bronchodilators, steroids 2. Risk factor control 3. Other atherosclerotic CV disease : PVD, stroke 4. Secondary prevention : Statins, BB, ACE-I | 40 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768823342_cardiology_1-6.pdf | Manage factors potentaiting angina - Anemia, Thyrotoxicosis, Pregnancy, febrille illness - Hypertension, Ventricular hypertrophy, CHF - Tachy or brady-arrhythmia - Drugs : bronchodilators, steroids 2. | 1 | page=1,block=44 | 0.700 | valid |