Return to Scenario ListShow Learning Points most relevant to Phase 1:

Stable angina

Clinical Discipline(s)/Organ System(s)
Cardiology, Cardiovascular System
Progress Test Topic(s)
You are on your GP placement and you are asked to see a 69 year old Tongan man who has a background of hypertension. He complains of chest pain when he walks and comments that it is particularly bad when he walks up hills or stairs. It gets better when he rests. You note that he is obese.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Innervation of the heart
   - Principles of referred pain
   - The role of lifestyles, such as exercise and diet, on disease development
   - Atherosclerotic plaque structure and relationship to clinical presentation
   - Histopathological changes in the heart during prolonged ischaemia
   - Pharmacology of beta adrenoceptor blocking drugs, nitrates, statins, calcium channel blockers
Clinical and Communication Skills 
   - History from a patient with stable angina; consider cardiovascular risk factors
   - Classify the severity of angina using the Canadian Cardiovascular Society Angina Grading Scale
   - Examination of a patient with angina
   - Perform and interpret an ECG
   - Indications for echocardiogram, exercise stress testing, myocardial perfusion scanning, CT angiogram, percutaneous coronary angiography
   - Differential diagnosis of stable angina
   - Management of stable angina
   - Complications of stable angina
   - Prognosis of stable angina
   - Assess cardiovascular risk; interpret HbA1c, cholesterol, chest X-ray
   - Primary and secondary preventative strategies for ischaemic heart disease
   - Role of non-medical interventions such as lifestyle modification and exercise programmes
Personal and Professional Skills 
   - Effectively communicate regarding lifestyle changes eliciting and incorporating the patient's views
   - Teach patients how to use medications correctly: glyceryl trinitrate (GTN) spray
Hauora Māori 
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand in cardiovascular disease
   - Understanding of inequities in access to health services and quality of medical care for Māori presenting with chest pain/cardiovascular disease, and application of this to clinical decision making and management
   - Understanding of the role of kaupapa Māori health policies, services and research in reducing cardiovascular disease inequalities
Population Health 
   - Origins of cardiovascular risk charts
   - Prevalence of cardiovascular risk factors
   - Epidemiology of angina
   - Classify cardiovascular risk factors into modifiable and non-modifiable
   - Population-wide approaches to control of cardiovascular risk factors
   - Cost-effective prevention of coronary heart disease
Conditions to be considered relating to this scenario
angina, aortic stenosis, hypertensive cardiomyopathy, gastro-oesophageal reflux disease
Less common but 'important not to miss'
hypertrophic obstructive cardiomyopathy
coronary artery vasospasm
Related Scenarios
[Acute chest pain]