Stable angina

22nd August 2011 by Louise Hudman

Overall, the main treatment of stable angina is not changed.

What advice should you give patients with angina?

  • Pacing activities and physical exertion – including sexual activity
  • Prognosis and the likelihood that they would benefit from surgical intervention (see below). Overall mortality is up to 5% per year. MI risk is up to 5% per year.
  • To seek advice if their symptoms worsen.
  • To call 999 if their angina doesn’t respond to 2 doses of GTN, 5 mins apart.

The British Heart Foundation booklet covers most of the suggested information.

Does surgical intervention alter prognosis?

Stents do not give any survival benefit. CABG can give survival benefit. This is small for multi-vessel disease (at 5 months over 10 yrs), but greater with left main stem disease (LMS) at 19 months over 10 yrs. Only a small number of people who are controlled on medication are likely to have LMS disease (this is likely to be less than 1% of patients). Therefore, if a patient is controlled on medication, you wouldn’t normally do angiography. It is encouraged that we discuss this concept with patients.

What drug treatment is advised for stable angina?

  • All patients – Short acting nitrate used before planned exertion.
  • 1st line: Beta-blocker or dihydropyridine calcium channel blocker. If one doesn’t work, try the other. If not controlled on one alone, then combine them together.
  • 2nd line – if only on a single drug, add in one of:
    • Long acting nitrate
    • Ivabradine
    • Nicorandil (unlicensed use)
    • Ranolazine

When should you refer on?

  • If the patient is not controlled on 2 drugs as above. It is OK to add in a 3rd drug whilst awaiting further investigation and treatment.

What secondary prevention medications are indicated?

  • Aspirin – to all
  • Statin – to all
  • ACE inhibitor – add in only if the patient also has diabetes or another indication for its use (eg CKD or hypertension). Don’t add in if there is no other indication as it is unlikely to make much difference.

Read more

No credit card details needed – it takes two minutes.

Join free trial

Login

Already a member? Login to view this content.

Login

"LocumDeck has given me the opportunity to work in different practices and meet new colleagues. I enjoy the flexibility of working on a locum basis. I found the initial setting up process straightforward, and there is plenty of help with the set up guides as well as support from Katrina Munro, the Nurse Ambassador at Frimley Training Hub, and Becky Nelson, the Nurse Support Manager at LocumDeck. I now have regular bookings on days and times which suit me."

Anon nurse, Frimley

See the full list of features within our NASGP membership plans

Membership