Stable Angina

Cardiology (12%) Core Clinical Conditions

2A: Once the condition has been diagnosed, either by their supervising doctor or a clinical specialist, the Physician Associate is able to manage the condition without routine referral.

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Stable angina or angina pectoris can be defined as a chest pain or discomfort caused by a restriction or reduction in blood flow to the heart. Stable angina is often caused by physical exertion or stress and is alleviated by rest or medicine.

Stable angina is primarily caused by the progression of atherosclerosis. This accumulation of fatty deposits (plaque) narrows the artery and reduces blood flow to the heart.

The coronary arteries supply oxygen-rich blood to the heart muscle. However, in individuals with stable angina, coronary artery constriction reduces blood flow to the heart muscle, resulting in a decrease in oxygen supply.

During physical exertion, the heart's demand for oxygen increases to meet the increased demand. However, as a result of atherosclerosis and constricted arteries, the heart muscle receives a diminished blood supply and is unable to meet the increased demand, resulting in ischemia and causing pain.

After cessation of physical exertion or emotional stress, or with the use of medications such as nitroglycerin, the demand for oxygen decreases, allowing the blood flow to the heart muscle to catch up.

• Older age individuals 

• Family history

• Smoking

• Hypertension 

• High cholesterol: raised LDL (low-density lipoprotein) cholesterol increases the plaque build up in the coronary arteries.

• Diabetes

• Obesity

• Sedentary lifestyle

• Chest pain 

• Shortness of breath (SOB)

• Perfused sweating

• Nausea/vomiting

• Dizziness 

• Fatigue

• Electrocardiogram 

• Blood tests: check troponin 

• ECHO

• Coronary angiography

• Cardiac magnetic resonance (CMR)

• CXR

Lifestyle changes: 

• Smoking cessation, healthy diet, healthy weight, and increased physical activity

• Encourage reduced alcohol consumption

Medication: 

• Sublingual glyceryl trinitrate (GTN) for rapid relief of symptoms, instruct patient to call an ambulance if pain persists despite use

• Beta-blocker or calcium-channel blocker (CCB) are first-line regular treatment

• Antiplatelet treatment (low-dose aspirin or clopidogrel) and ACE inhibitors are generally used as secondary prevention

• Statin used as adjunct

Referral: 

• Considerer referral to a cardiologist if patient has previous heart conditions + angina symptoms or abnormal ECG, or other risk factors

Procedures: cardiac angioplasty or coronary artery bypass surgery can be considered to improve blood flow to the heart.

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