Thread by @ZainAsadEP

1/6
Stable Angina #Tweetorial #FITSurvivalGuide
Chronic mismatch of myocardial oxygen supply and demand.
Epicardial CAD, vasospasm, microvascular disease,others cause it.
Chest discomfort occurring predictably, reproducibly with particular exertion, relieved with rest or NTG.

2/6 Symptoms #FITSurvivalGuide
CP or SOB,fatigue,weakness.
-Location:Retrosternal with radiation to back,shoulders,neck,arms,jaws,abdomen.
-Triggers:Activity, stress,cold,heavy meal,others.
-Character:Vague, squeezing, burning.
-Duration: Typically 3-5mins
-CCS Classification

3/6 Risk Stratification #FITSurvivalGuide
-Risk stratification helps decide GDMT only vs stress testing or Cath.
-Factors: Age, Gender, RF, ECG, TTE (EF,WMA), Duke Score.
-Low is <1%, Intermediate is 1-3%, High is >3% Annual risk of death/MI.

4/6 Stress Testing #FITSurvivalGuide
-Provoke ischemia or coronary vasodilation by exercise or drugs.
-Assess ischemia with ECG, echo or SPECT.
-Algorithm to pick b/w these modalities below.

5/6 Cath in Stable Angina #FITSurvivalGuide
-Persistent symptoms despite GDMT.
-High risk findings on non-invasive stress testing.
-Cannot undergo stress testing or clinical suspicion is high despite –ve stress test results.

6/6 GDMT #FITSurvivalGuide
-Diet, Wt loss, Exercise, RF Modification
-ASA, Statin (Mod-High Intensity)
-Sublingual NTG
-BB and/or CCB/Long-acting Nitrates
-Ranolazine

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