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:

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

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.

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.