Stable Angina (infrequent Attacks)

Clinical Description

Angina is due to poor blood flow through the blood vessels in the heart (coronary arteries).

It is chest pain or discomfort that most often occurs with activity or emotional stress

Signs and Symptoms

• Central chest pain (squeezing, heavy discomfort) with radiation to the left arm on exertion or at rest lasting 2-5 minutes, crescendo and decrescendo pattern

Investigations

• As in ischemic heart disease section above

Pharmacological

• Give Aspirin 150 mg daily

Acute relief of Angina

• Give Glyceryl Trinitrate 0.5 mg sublingually as required.
• Maximum 3 tablets per 15 minutes
• Deteriorates on storage: keep tablets in original container for no more than 3 months after opening
• Alternatively use Isosorbide Dinitrate 5-10mg sublingually as required instead of Glyceryl Trinitrate

Long term management

• Atenolol 50 mg 12 hourly (if not asthmatic)
• Amlodipine 5-10mg daily or Nifedipine 10-20 mg daily to replace or be cautiously added to Atenolol
• If pain continues despite the above treatment refer to Medical Specialist

Red flags

• Unstable angina, non-ST segment myocardial infarction
• Central chest pain as above lasting more than 10 minutes and has a crescendo pattern
• Acute myocardial Infarction (ST segment elevation)
• Typical angina pain plus most patients being restless, anxious, pale and with cold extremities

Treatment

• Nitrates and Morphine 2-5mg IV for pain control if there is no hypotension.

Note: Urgently discuss these patients with medical specialist!