Stable angina management

INVESTIGATIONS

• Haemoglobin to identify underlying anaemia
• Fasting Glucose to identify previously undiagnosed diabetes mellitus
• Random Total Cholesterol and Triglycerides, U & E’s, LFT’s, TFT’s
• Resting ECG

MANAGEMENT

• Referral to Cardiology or Rapid access chest pain clinic if appropriate on initiation of
  treatment, if patient is perceived to be at increased risk, if medical treatment fails to control
  symptoms or if the symptoms limit the patients desired activities
• Review at 6 months

PHYSIOLOGICAL AND LIFESTYLE RISK FACTORS

• Treat Cholesterol as per NHS Borders Statin policy
• Hypertension – treat as per Borders Hypertension Guideline
• Diabetes Mellitus – optimise control
  LIFESTYLE ADVICE
• Stop Smoking – refer to smoking cessation support service if appropriate
• Advise re Healthy Eating
• Encourage Patients to achieve BMI <25
• Regular exercise within limits set by disease
• Advise re safe alcohol intake
• Consider referral to well being service

MEDICATION (as per Borders Formulary)

• Aspirin Dispersible 75mgs daily in all patients (Genuine aspirin hypersensitivity consider Clopidogrel 75mgs daily)
• Beta Blocker –Bisoprolol or Metoprolol (if intolerant consider Diltiazem or Ivabradine
  aiming for resting pulse 60bpm)
• GTN spray
  SECOND LINE TREATMENT FOR SYMPTOM CONTROL
• Nitrate –Isosorbide Mononitrate or Monomax XL tablets if long acting required
• Calcium Channel Blockers –Felodipine, Amlodipine
• Potassium Channel Activators – Nicorandil (“Please be aware of new guidance around risks of oral and GI ulceration”)