Chronic stable angina Treatment

Question 1

How does Chronic Stable Angina normally get better?

Answer 1

Resting or Nitro Vasodilator

Question 2

What are the aims of treating Chronic Stable Angina?

Answer 2

Stop or minimise symptoms
improve quality of life and increase exercies tolerance
Reduce the risk of major CV events e.g. Myocardial Infarction

Question 3

Lifestyle changes in the Management of Chronic Stable Angina:

Answer 3

If necessary:

• weight loss
• Diet including reduce salt intake and reduce cholesterol
• Smoking cessation
• Alcohol units
• BP monitoring

Question 4

Treatment of acute attack:

Answer 4

• Short acting buccal NITRATE therapy fpr rapid pain relief, and the dose can be repeated after 5 minutes if the pain is not gone.
  Phone an ambulance if the Nitrate doesn’t provide relief
  Take the Nitrate therapy BEFORE any excercise to avoid an attack.

Question 5

What is the mecahnism of treatment for acute attack?

Answer 5

Mechanism is rabid venodilation and reduction in cardiac preload, which is the end diastolic volume that stretches the ventricels to its greatest dimensions, therefore decreasing the cardiac oxygen demand in longer term and decreasign the frequency of attacks.

Question 6

What is the reason for long-term management of chronic stable angina?

Answer 6

This is to reduce cardiac oxygen demand therefore reducing the frequency of attacks.

Question 7

How do we choose what is the treatment for long term management of chronic stable angina?

Answer 7

The treatment depends on the left ventricle function and how well tolerated the drugs are

Question 8

WHat is the 1st line treatment?

Answer 8

Beta-Blocker OR CCB

If LV dysfunction, use a low dose Beta blocker- AVOID verapamil (CCB)

Question 9

What is the step 2 in the treatment?

Answer 9

If there is inadequate response to step 1, use a Beta-blocker AND a dihydropyridine CCB like Amlodipine

Question 10

What is step 3 in the treatment?

Answer 10

Ensure step 2 is optimal before step 3, or if there is an intolerance, use or add a:
long acting nitrate like Isosorbinde mononitrate, or nicorandil.

Question 11

What is step 4 in the treatment?

Answer 11

If inadequate response with all possible pharmacological intervention, consider a REVASCULARISATION surgery for chronic stable angina.
The surgery will restore perfusion to the heart and prevent ischaemia.
Either a coronary artery bypass graft
or a precutaneous coronary intervention (catheter through major vessel

Question 12

What is the Secondary Prevention and Post-Revascularisation?

Answer 12

Low dose Aspirin 75mg for life
Consider and ACE inhibitor if not already on them
If not already, offer a ststin od for life