Diagnosis
- See CG95 for chest pain guidance
Investigation
Management
- Short acting nitrate for prevention and treatment: advice on use before planned exertion, and to sit down or hold onto something if feel light headed. Side effects of flushing and headache
- Repeat dose after 5 mins if symptoms persist, call an ambulance if pain persist 5 mins after 2nd dose
- Secondary prevention of Cardiovascular disease:
- Aspirin 75 mg taking into account bleeding risk
- ACE inhibitor if co-morbid diabetes and stable angina
- Statin for lipid lowering
- Treat hypertension
- First line treatment: Either Beta Blocker or CCB, switching between if either not tolerated, or in combination if not effective (though note B Blocker and Verapamil hypotension risk)
- Other monotherapy treatment if above not tolerated, or still not controlled
- Long acting nitrate
- Ivabradine
- Nicorandil
- Ranolazine
- Only offer 3 drugs in combination if revascularisation not appropriate
- If stable disease discuss prognosis, risk benefit of CABG if have disease of 3 proximal vessels or left main stem, and should be offered if functional testing highlights these diseases
- If symptoms still not controlled satisfactorily with medical treatment consider by-pass grafting (CABG) or PCI, which ever is more appropriate, together with coronary angiography to guide treatment
- Take into account survival benefit of CABG over PCI in patients > 65 or have diabetes or have complex 3 vessel disease (with or without involvement of left main stem
- MDT (surgeons and interventionalists) should discuss patients with complex 3 vessel disease or doubt about best method
NICE Source: CG126 Stable angina: management. Summary compiled by Dr D P Sheppard MBBS.
