Chronic stable angina

    • Chronic stable angina
      • Intermittent chest pain that occurs over a long period with same pattern of onset, duration, and intensity of symptoms
      • Few minutes in duration
      • ST segment depression and/or T-wave inversion
      • Control with drugs
    • Types of Angina
      • Silent ischemia
        • Ischemia that occurs in absence of any subjective symptoms
        • Associated with diabetic neuropathy
        • Confirmed by ECG changes
      • Prinzmetal’s (variant) angina
        • Rare
        • Occurs at rest
        • Can be seen in patients with a history of migraine headaches, Raynaud’s phenomenon and heavy smoking
        • Spasm of a major coronary artery
        • CAD may or may not be present
      • Microvascular angina
        • Syndrome X (Common in women)
        • Chest pain occurs in the absence of significant CAD or coronary spasm of a major coronary artery
        • Prevention and treatment follows CAD recommendations
    • Interprofessional care
      • Goal: decrease O2 demand and/or increase O2 supply
        • Short-acting nitrates
          • Dilate peripheral and coronary blood vessels
          • Give sublingually or by spray
          • If no relief in 5 minutes, call EMS; if some relief ,repeat every 5 minutes for maximum 3 doses
          • Patient teaching
          • Can use prophylactically
        • Long-acting nitrates
          • To reduce angina incidence
          • Main side effects: headache, orthostatic hypotension
          • Methods of administration
            • Oral
            • Nitroglycerin (NTG) ointment
            • Transdermal controlled-release NTG
        • Angiotensin-converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARBs)
        • β-Blockers
        • Calcium channel blockers
        • Lipid lowering drugs
          • Sodium current inhibitor
            • Ranolazine (Ranexa)
      • Diagnostic studies
        • Chest x-ray
        • 12-lead ECG
        • Laboratory studies
        • Echocardiogram
        • Exercise stress test
        • EBCT
        • CCTA
      • Cardiac catheterization/coronary angiography
        • Visualize blockages (diagnostic)
        • Open blockages (interventional)
          • Percutaneous coronary intervention (PCI)
          • Balloon angioplasty
          • Stent