whats given for symptom relief?
GTN spray
Prophylaxis: ONE – TWO sprays under the tongue or ONE tablet prior to activity likely to
cause angina.
– Treatment: ONE – TWO sprays under the tongue or ONE tablet at onset of chest pain.
Dose to be repeated after 5 minutes if chest pain remains. If chest pain has not resolved
5 minutes after the second dose, seek urgent medical attention (call 999).
first line
1) BB or CCB RLLCCB preferred
2) if one or other not working then BB + CCB together - should be dihydripidiine CCB
3) if still not tolerated/contraindicated then long acting nitrate/nicorandil/ivabradine/ranolazone as monotherapy.
review
review response to treatment 2-4 weeks after and after each dose change
secondary prevention
- aspirin 75mg
- statin - atorvastatin 80mg
other medications for secondary prevention
– if stroke/peripheral artery disease then they would be on clopidogrel so continue with that
- if they have diabetes add ACEI if needed
- offer antihypertensive treatment if needed, bp checked and elevated etc.
diagnostic investigations
– 12 lead ECG
– Blood tests
– CT coronary angiography, non-invasive functional imaging,
invasive coronary angiography
How should I review a person with established angina?
Review the person every 6 months to 1 year depending on the stability of their angina and their comorbidities.
