Stable angina Flashcards
Criteria of stable angina?
Typical anginal chest pain is defined:
- Constriction/heavy discomfort to chest that may radiate to the jaw/neck/arm.
- Brought on by exertion.
- Alleviated by rest (<5 minutes) or GTN spray.
3/3 features = typical angina pain
2/3 features = atypical angina pain
0-1/3 features = non-anginal pain
Presentation of stable angina?
Central, constricting chest pain that radiates to neck/jaw/arm.
Exertional chest pain that is relieved on rest/GTN.
Associated symptoms:
- nausea
- vomiting
- clamminess or sweating.
Diagnosis/IVx of stable angina?
1st line:
CT coronary angiogram (CTCA)
2nd line: (if CTCA unclear)
Stress echocardiogram
Myocardial perfusion SPECT
Cardiac MRI
3rd line: (above is unclear)
Invasive coronary angiography
Routine:
- ECG
- Bloods (FBCs, TFTs)
- Lifestyle modification
- Manage other RFs (HTN, DM, cholesterol)
Management of stable angina?
Lifestyle:
Smoking cessation
Glycaemic control
Hypertension
Hyperlipidaemia
Weight loss
Alcohol intake
Secondary prevention:
- aspirin 75mg OD
- statin 80mg ON
- GTN spray for symptom relief (seek emergency help if two doses doesn’t relief)
Anti-anginal medications
1st line = BB (bisoprolol) or CCB (verapamil or diltiazem)
- if neither can be tolerated, consider a long-acting nitrate (ISMN), ivabradine, nicorandil or ranolazine.
2nd line = BB (bisoprolol) AND long-acting dihydropyridine CCB (amlodipine or nifedipine)
3rd line = BB (bisoprolol) AND long-acting dihydropyridine CCB AND long-acting nitrate.
Revascularisation with coronary artery bypass graft or PCI must be considered if sx not controlled despite optimum tx or complex 3 vessel disease.
