This comprises stable angina pectoris and acute coronary syndromes.
STABLE ANGINA PECTORIS
Stable angina pectoris refers to recurrent chest pain typically induced
by exertion or emotional stress and relieved by rest or glyceryl trinitrate.
Individuals who experience stable angina pectoris are at a high risk of
developing acute coronary syndromes or a heart attack. Risk factors include
diabetes mellitus, hypertension, cigarette smoking, plasma lipid
abnormalities, obesity, a family history of heart disease and elevated
markers of inflammation such as C-reactive protein.
Taken together, stable angina pectoris and acute coronary syndrome
are termed, Ischeamic heart disease.
CAUSES
· Atherosclerosis with narrowing of the coronary blood vessels or spasm
of the vessels leading to reduction in blood supply to the heart without
destruction of the heart muscle.
SYMPTOMS
· Central or precordial chest pain
· May radiate into the left arm, neck or jaw
· Relieved by rest
· Relieved by glyceryl trinitrate
SIGNS
· No typical signs
· The following may be observed:
· Obesity
· Hypertension
· Xanthelasmata etc.
INVESTIGATIONS
· FBC
· Erythrocyte Sedimentation Rate
· ECG
· Cardiac enzymes: creatinine kinase-MB (CK-MB), serum aspartate
transaminase (AST), serum lactic dehydrogenase (LDH) and troponins
· Blood glucose
· Blood lipid profile
DISORDERS OF THE CARDIOVASCULAR SYSTEM
TREATMENT
Treatment objectives
· To minimise symptoms
· To prevent or reduce ischaemia
· To prevent myocardial infarction
· To identify and manage remediable risk factors
Non-pharmacological treatment
· Reassure patient
· Encourage cessation of smoking
· Ensure weight reduction (in overweight and obese individuals)
· Encourage regular exercise within limits of exercise capacity.
Pharmacological treatment
(Evidence rating: A)
Immediate Treatment
· Glyceryl trinitrate, sublingual,
500 microgram stat
Long-term Treatment
· Aspirin, oral,
75 mg daily
· Atenolol, oral,
50-100 mg, daily (avoid if beta-blockers are contraindicated e.g.
asthma, heart failure)
· Isosorbide Dinitrate, oral,
10 mg 8-12 hourly
· Optimise or initiate treatment for hypertension
· Optimise or initiate treatment for diabetes mellitus
· Treat abnormal blood lipids to target levels
REFER
Refer all patients to a physician specialist.
