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Management of stable angina 

Management of stable angina
Chapter:
Management of stable angina
Author(s):

Adam D. Timmis

DOI:
10.1093/med/9780198746690.003.0366
Page of

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date: 07 March 2021

Angina—the pain provoked by myocardial ischaemia—is usually caused by obstructive coronary artery disease that is sufficiently severe to restrict oxygen delivery to the cardiac myocytes. Quality of life is impaired in direct proportion to the severity of symptoms.

Clinical history remains the most useful basis for diagnosis and referral decisions to specialist services, the commonest indications being (1) new-onset angina; (2) exclusion of angina in high-risk individuals with atypical symptoms; (3) worsening angina in a patient with previously stable symptoms; (4) new or recurrent angina in a patient with history of myocardial infarction or coronary revascularization; (5) assessment of occupational fitness (e.g. airline pilots). Cardiac investigation is usually unnecessary in patients with non-anginal chest pain, but residual diagnostic uncertainty can be resolved in those with atypical or typical angina by CT coronary angiography, which is now the non-invasive test of choice.

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