Overview of stable angina
Angina is defined as retrosternal chest discomfort (pain or tightness) that lasts 10 minutes or less and subsides promptly with rest. It occurs when myocardial oxygen demand exceeds supply, which is usually restricted by atherosclerotic obstruction. Angina is commonly triggered by physical activity or emotional stress.
Angina is considered stable if the pattern of symptoms (eg distance walked before development of angina, allowing for terrain, meals or cold weather) has not changed during the past month.
Investigate chest pain appropriately before making a diagnosis of angina; see Acute chest pain of possible cardiac origin for information on diagnosis of acute chest pain. Conditions such as anaemia and valvular heart disease can mimic typical angina, so a careful history is critical to diagnosis.
Consider the possible presence of significant comorbidities such as anaemia, aortic stenosis, thyrotoxicosis and hypertrophic cardiomyopathy, and treat as appropriate.
Treatment of stable angina aims to relieve symptoms, which involves treatment of episodes of angina and treatment to prevent angina. It also aims to prevent cardiovascular events by ensuring optimal management of underlying coronary artery disease and modifiable risk factors, including:
- elevated blood pressure (see Hypertension and blood pressure reduction)
- smoking (see Smoking cessation)
- dyslipidaemia (see Lipid modification)
- exercise and healthy eating (see Physical activity and cardiovascular disease risk and Nutrition and cardiovascular disease risk)
- excess body weight (see Overweight and obese patients and cardiovascular disease risk)
- diabetes (see the Diabetes guidelines).
Work with patients to set clear goals and targets for managing risk factors. Provide advice on the value of a graded program of regular moderate exercise and the need to avoid heavy, sudden and unaccustomed exertion and acute emotional stress. Education about the improvement in cardiovascular outcomes (which may be achievable by management of risk factors), can be encouraging for patients and their families.
Screen patients for depression and treat if present. See Overview of depressive disorders for information on management of depression.
Patients should receive an annual influenza vaccine and remain up to date with their pneumococcal and other vaccinations. For details, see the Australian Immunisation Handbook.