Stable Angina
- Created by: Melissaloughlin
- Created on: 21-04-23 22:45
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- Stable Angina
- Chest pain caused by insufficient blood flow to the myocardium
- Usually caused by coronary artery disease
- Usually occurs PREDICTABLY after physical exertion or emotional stress
- Can also be caused by eating large meal or exposure to cold
- Relieved within minutes of rest
- or with a dose of glyceryl trinitrate (GTN)
- 1-2 sprays under the tongue prn
- If no improvement within 5 mins - repeat dose
- If still no improvement after another 5 mins then call 999
- If no improvement within 5 mins - repeat dose
- 1-2 sprays under the tongue prn
- or with a dose of glyceryl trinitrate (GTN)
- Management
- Lifestyle modifications:
- Smoking cessation
- Cardio-protective diet
- Limit alcohol
- Weight loss if overweight
- Increased activity levels
- Drug treatment:
- Sublingual GTN for rapid relief
- Also to be used before known activities to cause angina
- Regular treatment
- 1st line: beta-blocker or CCB
- 2nd line: long-acting nitrate (isosorbide mononitrate) or nicorandil, ivabradine, ranolazine
- If symptom control is poor on max dose then add in another of different class
- If this fails then refer to cardiologist
- Sublingual GTN for rapid relief
- Secondary Prevention
- Antiplatelet - Aspirin 75mg OD
- ACE inhibitor
- Statin if appropriate
- Anti-hypertensives if appropriate
- Lifestyle modifications:
- Medication Interactions
- Concomitant use of a nitrate and vardenafil is CONTRA-INDICATED
- 24hrs between a dose of sildenafil and a nitrate
- 48 hrs between a dose of tadalafil and a nitrate
- If there is an angina attack within a dose then patient should call 999
- Chest pain caused by insufficient blood flow to the myocardium
- Nitrates
- Converts to nitric oxide (NO) - a potent vasodilator
- Prolonged use of nitrates leads to tolerance and reduces its effectiveness over time
- Nitrate-free period required
- Common side effects: headaches, dizziness, flushing
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