Stable angina is characterized by chest pain or discomfort brought on by exertion or stress and relieved by rest. It is caused by an imbalance between myocardial oxygen supply and demand, often due to coronary artery disease. Investigations like exercise ECG, myocardial perfusion scanning, and stress echocardiography can help evaluate the extent of ischemia. Management involves risk factor control, medications to relieve symptoms, and procedures like coronary angiography and revascularization for high-risk patients. Lifestyle modifications like exercise, smoking cessation, and sublingual nitrates for exertion can help control symptoms.
Stable angina is characterized by chest pain or discomfort brought on by exertion or stress and relieved by rest. It is caused by an imbalance between myocardial oxygen supply and demand, often due to coronary artery disease. Investigations like exercise ECG, myocardial perfusion scanning, and stress echocardiography can help evaluate the extent of ischemia. Management involves risk factor control, medications to relieve symptoms, and procedures like coronary angiography and revascularization for high-risk patients. Lifestyle modifications like exercise, smoking cessation, and sublingual nitrates for exertion can help control symptoms.
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Stable angina is characterized by chest pain or discomfort brought on by exertion or stress and relieved by rest. It is caused by an imbalance between myocardial oxygen supply and demand, often due to coronary artery disease. Investigations like exercise ECG, myocardial perfusion scanning, and stress echocardiography can help evaluate the extent of ischemia. Management involves risk factor control, medications to relieve symptoms, and procedures like coronary angiography and revascularization for high-risk patients. Lifestyle modifications like exercise, smoking cessation, and sublingual nitrates for exertion can help control symptoms.
Stable angina is characterized by chest pain or discomfort brought on by exertion or stress and relieved by rest. It is caused by an imbalance between myocardial oxygen supply and demand, often due to coronary artery disease. Investigations like exercise ECG, myocardial perfusion scanning, and stress echocardiography can help evaluate the extent of ischemia. Management involves risk factor control, medications to relieve symptoms, and procedures like coronary angiography and revascularization for high-risk patients. Lifestyle modifications like exercise, smoking cessation, and sublingual nitrates for exertion can help control symptoms.
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Stable angina
Introduction
Angina pectoris is the symptom complex caused by transient myocardial
ischaemia and constitutes a clinical syndrome rather than a disease. It may occur whenever there is an imbalance between myocardial oxygen supply and demand Coronary atheroma is by far the most common cause of angina, although the symptom may be a manifestation of other forms of heart disease, particularly aortic valve disease and hypertrophic cardiomyopathy Clinical features Stable angina is characterised by central chest pain, discomfort or breathlessness that is precipitated by exertion or other forms of stress, and is promptly relieved by rest Some patients find the discomfort comes when they start walking, and that later it does not return despite greater effort and this is called “warm-up angina” Physical examination is frequently unremarkable but should include a careful search for evidence of valve disease particularly aortic, important risk factors e.g.hypertension, diabetes mellitus, left ventricular dysfunction cardiomegaly, gallop rhythm, other manifestations of arterial disease such as carotid bruits, peripheral vascular disease and unrelated conditions that may exacerbate angina including anaemia and thyrotoxicosis Investigations Resting ECG - The ECG may show evidence of previous MI but is often normal, even in patients with severe coronary artery disease. Occasionally, there is T- wave flattening or inversion in some leads, providing non-specific evidence of myocardial ischaemia or damage. The most convincing ECG evidence of myocardial ischaemia is the demonstration of reversible ST segment depression or elevation, with or without T-wave inversion, at the time the patient is experiencing symptoms whether spontaneous or induced by exercise testing Exercise ECG - An exercise tolerance test (ETT) is usually performed using a standard treadmill or bicycle ergometer protocol while monitoring the patient’s ECG, BP and general condition. Planar or down-sloping ST segment depression of 1 mm or more is indicative of ischaemia. Up-sloping ST depression is less specific and often occurs in normal individuals. Exercise testing is also a useful means of assessing the severity of coronary disease and identifying high-risk individuals. For example, the amount of exercise that can be tolerated and the extent and degree of any ST segment change provide a useful guide to the likely extent of coronary disease. Exercise testing is not infallible and may produce false-positive results in the presence of digoxin therapy, left ventricular hypertrophy, bundle branch block or WPW syndrome Myocardial perfusion scanning - This may be helpful in the evaluation of patients with an equivocal or uninterpretable exercise test and those who are unable to exercise Stress echocardiography - This is an alternative to myocardial perfusion scanning and can achieve similar predictive accuracy. It uses transthoracic echocardiography to identify ischaemic segments of myocardium and areas of infarction Coronary arteriography - This provides detailed anatomical information about the extent and nature of coronary artery disease, and is usually performed with a view to coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). In some patients, diagnostic coronary angiography may be indicated when non-invasive tests have failed to establish the cause of atypical chest pain. The procedure is performed under local anaesthesia and requires specialized radiological equipment, cardiac monitoring and an experienced operating team Management: general measures
The management of angina pectoris involves:
• A careful assessment of the likely extent and severity of arterial disease • The identification and control of risk factors such as smoking, hypertension and hyperlipidaemia • The use of measures to control symptoms • The identification of high-risk patients for treatment to improve life expectancy Management should start with a careful explanation of the problem and a discussion of the potential lifestyle and medical interventions that may relieve symptoms and improve prognosis. Anxiety and misconceptions often contribute to disability; for example, some patients avoid all forms of exertion because they believe that each attack of angina is a ‘mini heart attack’ that results in permanent damage. Effective management of these psychological factors can make a huge difference to the patient’s quality of life Advice to patients with stable angina: Do not smoke Aim for ideal body weight Take regular exercise - exercise up to, but not beyond, the point of chest discomfort is beneficial and may promote collateral vessels) Avoid severe unaccustomed exertion, and vigorous exercise after a heavy meal or in very cold weather Take sublingual nitrate before undertaking exertion that may induce angina