ANGINA PECTORIS, STABLE

DESCRIPTION 

Characteristic chest pain due to myocardial ischaemia usually occurring on exercise and relieved by rest.

GENERAL MEASURES

»     Lifestyle modification.

Ischaemic heart disease and atherosclerosis, prevention.

 

MEDICINE TREATMENT

Long-term prophylaxis for thrombosis:

  • Aspirin, oral, 75–150 mg daily with food. PLUS

Relief of angina:

READ ALSO  CELLULITIS AND ERYSIPELAS

Nitrates, short acting e.g.:

  • Isosorbide dinitrate, SL, 5 mg.
    • May be repeated if required at 5-minute intervals for 3 or 4 doses.

PLUS

Step 1

  • Atenolol, oral, 50–100 mg daily.
    • Titrate to resting heart rate of approximately 60 beats/minute.

If ß-blocker cannot be tolerated or is contraindicated, consider long acting calcium channel blocker.

Step 2  

ADD

READ ALSO  IMPETIGO

Long acting calcium channel blocker e.g.:

  • Amlodipine, oral, 5 mg.

Step 3 ADD

  • Isosorbide mononitrate, oral, 10–20 mg.
    • To provide a nitrate-free period to prevent tolerance, take at 8:00 and 14:00.
    • Modify for night shift workers. OR
  • Isosorbide dinitrate, oral, 20–40 mg.
    • To provide a nitrate-free period to prevent tolerance, take at 8:00 and 14:00.
    • Modify for night shift workers.
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HMGCoA reductase inhibitors, e.g.:

  • Simvastatin, oral, 10 mg daily.

Therapy should be initiated together with appropriate lifestyle modification. Ischaemic  heart  disease and atherosclerosis, prevention.

REFERRAL

»     When diagnosis is in doubt.

»     Failed medical therapy.

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