Angina pectoris is considered to be stable if the pattern of symptoms has not changed for a month. For example, when the distance the patient can walk, before pain develops, remains the same.
eTG complete says that the treatment of stable angina has several aims. These are to reduce myocardial oxygen demand, increase oxygen availability, improve coronary artery blood flow and prevent the progression of atherosclerotic plaques.
Reversible risk factors such as obesity and smoking should be addressed. Comorbidities such as diabetes and hypertension need to be well managed.
eTG complete recommends early referral of patients with stable angina. This enables them to be evaluated for coronary revascularisation.
When stable angina is managed with medications, the aim is to prevent pain. However, the patient should still know how to use glyceryl trinitrate if acute angina develops.
Beta blockers are known to reduce the risk of death in patients who have had a previous myocardial infarction. eTG complete recommends atenolol or metoprolol tartrate to prevent angina.
If the patient has a contraindication to beta blockers, a calcium channel blocker can be used. eTG complete suggests a long-acting formulation of diltiazem or verapamil.
Long-acting nitrates may be prescribed for stable angina, but there is no evidence that they improve survival and tolerance develops rapidly. To avoid this complication, eTG complete advises a daily nitrate-free period. This can be achieved by wearing a glyceryl trinitrate patch for less than 14 hours per day or taking long-acting isosorbide mononitrate once a day.
Dr John Dowden
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