The GP explains to Bryan that angina is a symptom of coronary artery disease. This could be due to the build up of fatty deposits within his heart arteries leading to a lack of of oxygen that the heart requires. She uses a poster to show how this build up can occur all over the body and Bryan needs to look at reducing his risks. The GP wants to do some more tests to confirm the diagnosis.
The GP tells Bryan from his clinical history that she suspects his symptoms may be due to angina.
- BP – Bryan’s blood pressure is high at 150/85. At this stage this needs to be monitored. This will need to be revisited to exclude hypertensive disease.
- P – The GP takes a manual pulse to check rate and rythym. Bryan’s pulse is 80 and regular.
- Bloods – Routine bloods, haemoglobin level, fasting blood glucose, thyroid function, cholesterol.
- ECG – A baseline 12 lead ECG should be performed in every patient with suspected angina. Please note a normal ECG does not exclude a diagnosis of coronary heart disease. Bryan’s ECG is normal with a heart rate of 80.
- Risk factors – The likelihood of a diagnosis increases with the number of cardiovascular risk factors in individual patients. Even if the chest pain sounds like it may not be cardiac it is essential to do a risk factor profile. Risk profile at this stage: non smoker, overweight (BMI 28) but not clinically obese, some family history in that his grandfather had a heart attack at age 64 however this is not relevant as this is not a first degree relative age less than or equal to 55. He leads a sedentary life with no formal exercise, Cholesterol and glucose are unknown at this satge. So the main risk factors of note at this stage are possible hypertension and inactivity.
Pulse point
See Module 1 for more information about the tests. See the Introduction to Stable Angina to review the areas atherosclerosis can occur and the associated problems that can happen.
Page last reviewed: 01 Jun 2020
