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Stable Angina

Stable angina occurs when there's atherosclerotic narrowing of coronary arteries, therefore leading to reduced perfusion on exertion (when demand of the heart increases). It's risk factors include:

  • Elderly

  • Male

  • IHD

  • Family history

  • CVS risk factors e.g. Smoking, HTN, DM, Obesity, Hyperlipidaemia


Presents with:

  • Constricting/heavy chest pain, which radiates to the jaw/neck/left arm

  • Exertional symptoms (worse on movement, eating etc.)

  • Symptoms relieved by rest or GTN spray

    • If only 2 of these features are present, it's called Atypical Angina


Features that would make a diagnosis of stable angina less likely includes:

  • Continuous/prolonged pain despite 2 doses of GTN

  • Unrelated to activity

  • Pleuritic pain

  • Associated dizziness, palpitations, tingling, or dysphagia


Classification

Investigations

1st line investigation to do is a CT Coronary Angiogram. If the patient has renal impairment, do a myocardial perfusion scan instead. Other investigations to do includes:

  • ECG - usually normal

  • Bloods - FBC (exclude anaemia), TFTs (exclude hyperthyroid), U&Es, LFTs, Lipid profile, Glucose

  • Echo


Management

  • Lifestyle changes - Smoking cessation, reducing alcohol, weight loss, diet, better diabetic/pressure control

  • All patients should be started on:

    • Sublingual GTN - for rapid relief of symptoms

    • B-blocker/CCB - for long-term symptomatic relief

  • 2nd line - Start patient on all 3 medications (GTN + B-blocker + CCB)

  • 3rd line - Revascularisation with CABG or PCI w/stenting (done if symptoms not well controlled despite optimal medical management or there's extensive disease/stenosis)


N.B. PCI is more cost-effective, but CABG has a better mortality risk for those with more severe disease.


Patients should seek medical attention if they have no improvement despite 2 doses of GTN (may indicate ACS).



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