Stable Angina

Pathology

Pain caused by myocardial ischaemia when myocardial oxygen demand exceeds supply

Aetiology

Usually coronary stenosis due to atheroma, but can result from anything that causes demand-supply mismatch including tachycardia, anaemia, left ventricular hypertrophy, aortic stenosis, and hypotension

Signs

Patients usually identify ischaemic pain with an open palm or fist over the centre of the chest (Levine’s sign), rather than by pointing

Symptoms

Central chest heaviness or tightness precipitated by exertion or emotional stress and relieved by rest

Heavy arms, nausea, fatigue, breathlessness

Investigations

Bloods: FBC, U&E, lipid profile, blood glucose

ECG: ST depression

Exercise Tolerance Test: Assesses severity of disease

Stress Echo: Assesses adequacy of blood supple when heart rate increased

Coronary CT: Non-invasive method to image coronary arteries

Coronary Angiography: Invasive method to image coronary arteries

Myocardial Perfusion Scan: Assesses blood flow to cardiac muscle.

Treatment

• Lifestyle adjustment
• Reverse precipitants
• Aspirin
• Anti-anginal medication (nitrates, nicorandil, β-receptor antagonists)
• Aggressive risk factor control - hypertension, diabetes and hyperlipidaemia

Prognosis

Acute coronary syndromes, arrhythmias, heart failure

Annual risk of non-fatal MI 12% and mortality rate 15%

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