272.2 🩺 國考版

272.2.1 高頻考點

272.2.1.1 Diagnostic Workflow

  • Typical angina (3/3) — substernal + exertional + relieved by rest/NTG
  • Pretest probability drives next test:
    • Low (< 5%): no test
    • Intermediate (5-50%): stress imaging or CCTA
    • High (> 50%): cath
  • CCTA indicated for stable chest pain (2024 NICE/ESC Class I)
  • FFR ≀ 0.80 = significant coronary stenosis

272.2.1.2 Treatment Algorithm

  • All CCS: lifestyle + ASA + statin + sublingual NTG
  • First anti-anginal: β-blocker OR CCB
  • Add long-acting nitrate if symptomatic
  • Refractory: ranolazine or ivabradine
  • Revascularize for refractory symptoms OR high-risk anatomy

272.2.1.3 Key Trial Take-Aways

  • COURAGE / BARI 2D / ISCHEMIA: routine PCI in stable CCS → no mortality benefit vs OMT
  • CABG > PCI for LM, 3VD + DM (FREEDOM), low EF (SYNTAX score)
  • SCOT-HEART: CCTA-guided strategy ↓ 5-year MI
  • ORBITA-2 2023: properly conducted blinded trial showed PCI improves symptoms

272.2.1.4 Drug Targets (Memorize)

  • Bisoprolol 5-10 mg, carvedilol 25-50 mg BID
  • Amlodipine 5-10 mg
  • Atorvastatin 80 mg (high-intensity), goal LDL < 55
  • ASA 81 mg lifelong
  • Resting HR target 55-60 bpm

272.2.2 易混淆比范

Type Trigger Relief ECG Treatment
Stable angina Exertion Rest/NTG ST↓ on stress β-blocker + CCB
Vasospastic Rest/early AM NTG ST↑ transient CCB + nitrate (NO β-blocker)
Microvascular Mixed Variable + stress test, clean arteries Anti-anginal + statin + ACEi
ACS Variable, rest Persistent ST↓ or T inv (NSTE) or ST↑ Reperfusion (Ch272-273)